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Sample records for planned home births

  1. PLANNED HOME BIRTH: A REVIEW

    Directory of Open Access Journals (Sweden)

    Tamara Serdinšek

    2016-05-01

    Full Text Available Background: Home birth is as old as humanity, but still most middle- and high-income countries consider hospitals as the safest birth settings, as complications regarding birth are highly unpredictable. Despite this there are a few countries in which home birth in integrated into official healthcare system (the Netherlands, United Kingdom, Canada etc.. Home births can be divided into unplanned and planned, and the latter can be further categorized by the presence of the birth attendants. This review focuses on planned home births, which are differently represented throughout the world. In the United States 0.6-1.0% of all children are born at home, in the United Kingdom 2-3%, in Canada 1.6% and in the Netherlands 20-30%. For Slovenia, the number of planned home births is unknown; however, in 2010 0.1% of children were born outside medical facilities.Conclusions: The safety of home birth in still under the debate. While research confirms smaller number of obstetric interventions and some complications in mothers who give birth at home, the data regarding the neonatal and perinatal mortality and morbidity is still conflicting. This confirms the need for large multicentric trials in this field. Current home birth guidelines emphasize that women should be well informed regarding the possible advantages and disadvantages of home births. In addition, the emphasis is on definition of selection criteria for home birth, indications for intrapartal transfer to the hospital and appropriate education of birth attendants. 

  2. Planned home birth: the professional responsibility response.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L; Levene, Malcolm I; Arabin, Birgit

    2013-01-01

    This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth. We start with patient safety and show that planned home birth has unnecessary, preventable, irremediable increased risk of harm for pregnant, fetal, and neonatal patients. We document that the persistently high rates of emergency transport undermines patient safety and satisfaction, the raison d'etre of planned home birth, and that a comprehensive analysis undermines claims about the cost-effectiveness of planned home birth. We then argue that obstetricians and other concerned physicians should understand, identify, and correct the root causes of the recrudescence of planned home birth; respond to expressions of interest in planned home birth by women with evidence-based recommendations against it; refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth. We explain why obstetricians should not participate in or refer to randomized clinical trials of planned home vs planned hospital birth. We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital. Copyright © 2013 Mosby, Inc. All rights reserved.

  3. [Outcomes after planned home births].

    Science.gov (United States)

    Blix, Ellen; Øian, Pål; Kumle, Merethe

    2008-11-06

    About 150 planned home births take place in Norway annually. Professionals have different opinions on whether such births are safe or not. The aim of the present study was to perform a systematic literature review on maternal and neonatal outcomes after planned home births. A review was performed of literature retrieved from searches in MEDLINE, PubMed, Embase, Cinahl and The Cochrane Library and relevant references found in the articles. The searches were limited to studies published in 1985 and later. 10 studies with data from 30 204 women who had planned and were selected to home birth at the onset of labour were included. Three of the studies had control groups including women with planned hospital births. All included studies were assessed to be of medium quality. Between 9.9 and 23.1 % of women and infants were transferred to hospital during labour or after birth. There were few caesarean sections, other interventions or complications in the studies assessed; the total perinatal mortality rate was 2.9/1000 and the intrapartum mortality rate 0.8/1000. There is no sound basis for discouraging low-risk women from planning a home birth. Results from the included studies do not directly apply to Norwegian conditions. Outcomes and transfers after planned home births should be systematically registered.

  4. Planned hospital birth versus planned home birth

    DEFF Research Database (Denmark)

    Olsen, O.; Clausen, J.A.

    2012-01-01

    Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications. This is an update of a Cochrane review first published in 1998....

  5. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.

    Science.gov (United States)

    Wax, Joseph R; Lucas, F Lee; Lamont, Maryanne; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

    2010-09-01

    We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth. We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes' summary odds ratios with 95% confidence intervals were calculated. Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates. Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate. Copyright 2010 Mosby, Inc. All rights reserved.

  6. PLANNED HOME BIRTH: A REVIEW

    OpenAIRE

    Tamara Serdinšek; Iztok Takač

    2016-01-01

    Background: Home birth is as old as humanity, but still most middle- and high-income countries consider hospitals as the safest birth settings, as complications regarding birth are highly unpredictable. Despite this there are a few countries in which home birth in integrated into official healthcare system (the Netherlands, United Kingdom, Canada etc.). Home births can be divided into unplanned and planned, and the latter can be further categorized by the presence of the birth attendants. Thi...

  7. Planned home births: the need for additional contraindications.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Sapra, Katherine J; Arabin, Birgit; Chervenak, Frank A

    2017-04-01

    Planned home births in the United States are associated with fewer interventions but with increased adverse neonatal outcomes such as perinatal and neonatal deaths, neonatal seizures or serious neurologic dysfunction, and low 5-minute Apgar scores. The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice states that, to reduce perinatal death and to improve outcomes at planned home births, strict criteria are necessary to guide the selection of appropriate candidates for planned home birth. The committee lists 3 absolute contraindications for a planned home birth: fetal malpresentation, multiple gestations, and a history of cesarean delivery. The aim of this study was to evaluate whether there are risk factors that should be considered contraindications to planned home births in addition to the 3 that are listed by the American College of Obstetricians and Gynecologists. We conducted a population-based, retrospective cohort study of all term (≥37 weeks gestation), normal weight (≥2500 grams), singleton, nonanomalous births from 2009-2013 using the Centers for Disease Control and Prevention's period-linked birth-infant death files that allowed for identification of intended and unintended home births. We examined neonatal deaths (days 0-27 after birth) across 3 groups (hospital-attended births by certified nurse midwives, hospital-attended births by physicians, and planned home births) for 5 risk factors: 2 of the 3 absolute contraindications to home birth listed by the American College of Obstetricians and Gynecologists (breech presentation and previous cesarean delivery) and 3 additional risk factors (parity [nulliparous and multiparous], maternal age [women home births (12.1 neonatal death/10,000 deliveries; Pbirths by certified nurse midwives (3.08 neonatal death/10,000 deliveries) or physicians (5.09 neonatal death/10,000 deliveries). Neonatal mortality rates were increased significantly at planned home births, with the

  8. Birth outcomes of planned home births in Missouri: a population-based study.

    Science.gov (United States)

    Chang, Jen Jen; Macones, George A

    2011-08-01

    We evaluated the birth outcomes of planned home births. We conducted a retrospective cohort study using Missouri vital records from 1989 to 2005 to compare the risk of newborn seizure and intrapartum fetal death in planned home births attended by physicians/certified nurse midwives (CNMs) or non-CNMs with hospitals/birthing center births. The study sample included singleton pregnancies between 36 and 44 weeks of gestation without major congenital anomalies or breech presentation ( N = 859,873). The adjusted odds ratio (aOR) of newborn seizures in planned home births attended by non-CNMs was 5.11 (95% confidence interval [CI]: 2.52, 10.37) compared with deliveries by physicians/CNMs in hospitals/birthing centers. For intrapartum fetal death, aORs were 11.24 (95% CI: 1.43, 88.29), and 20.33 (95% CI: 4.98, 83.07) in planned home births attended by non-CNMs and by physicians/CNMs, respectively, compared with births in hospitals/birthing centers. Planned home births are associated with increased likelihood of adverse birth outcomes. © Thieme Medical Publishers.

  9. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.

    Science.gov (United States)

    Janssen, Patricia A; Saxell, Lee; Page, Lesley A; Klein, Michael C; Liston, Robert M; Lee, Shoo K

    2009-09-15

    Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes. The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00-1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00-1.43) among women attended by a midwife and 0.64 (95% CI 0.00-1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.36; assisted vaginal delivery, RR 0.41, 95% 0.33-0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28-0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49-0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14-0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24-0.59). The findings were similar in the comparison with

  10. Characteristics of planned and unplanned home births in 19 States.

    Science.gov (United States)

    Declercq, Eugene; Macdorman, Marian F; Menacker, Fay; Stotland, Naomi

    2010-07-01

    To estimate the differences in the characteristics of mothers having planned and unplanned home births that occurred at home in a 19-state reporting area in the United States in 2006. Data are from the 2006 U.S. vital statistics natality file. Information on whether a home birth was planned or unplanned was available from 19 states, representing 49% of all home births nationally. Data were examined by maternal age, race or ethnicity, education, marital status, live birth order, birthplace of mother, gestational age, prenatal care, smoking status, state, population of county of residence, and birth attendant. We could not identify planned home births that resulted in a transfer to the hospital. Of the 11,787 home births with planning status recorded in the 19 states studied here, 9,810 (83.2%) were identified as planned home births. The proportion of all births that occurred at home that were planned varied from 54% to 98% across states. Unplanned home births are more likely to involve mothers who are non-white, younger, unmarried, foreign-born, smokers, not college-educated, and with no prenatal care. Unplanned home births are also more likely to be preterm and to be attended by someone who is neither a doctor nor a midwife and is listed as either "other" or "unknown." Planned and unplanned home births differ substantially in characteristics, and distinctions need to be drawn between the two in subsequent analyses. III.

  11. Perinatal risks of planned home births in the United States.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Brent, Robert L; Arabin, Birgit; Levene, Malcolm I; Chervenak, Frank A

    2015-03-01

    We analyzed the perinatal risks of midwife-attended planned home births in the United States from 2010 through 2012 and compared them with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) for planned home births. Data from the US Centers for Disease Control and Prevention's National Center for Health Statistics birth certificate data files from 2010 through 2012 were utilized to analyze the frequency of certain perinatal risk factors that were associated with planned midwife-attended home births in the United States and compare them with deliveries performed in the hospital by certified nurse midwives. Home birth deliveries attended by others were excluded; only planned home births attended by midwives were included. Hospital deliveries attended by certified nurse midwives served as the reference. Perinatal risk factors were those established by ACOG and AAP. Midwife-attended planned home births in the United States had the following risk factors: breech presentation, 0.74% (odds ratio [OR], 3.19; 95% confidence interval [CI], 2.87-3.56); prior cesarean delivery, 4.4% (OR, 2.08; 95% CI, 2.0-2.17); twins, 0.64% (OR, 2.06; 95% CI, 1.84-2.31); and gestational age 41 weeks or longer, 28.19% (OR, 1.71; 95% CI, 1.68-1.74). All 4 perinatal risk factors were significantly higher among midwife-attended planned home births when compared with certified nurse midwives-attended hospital births, and 3 of 4 perinatal risk factors were significantly higher in planned home births attended by non-American Midwifery Certification Board (AMCB)-certified midwives (other midwives) when compared with home births attended by certified nurse midwives. Among midwife-attended planned home births, 65.7% of midwives did not meet the ACOG and AAP recommendations for certification by the American Midwifery Certification Board. At least 30% of midwife-attended planned home births are not low risk and not within

  12. Planned and unplanned home births and hospital births in Calgary, Alberta, 1984-87.

    Science.gov (United States)

    Abernathy, T J; Lentjes, D M

    1989-01-01

    Information collected on all home births in Calgary (Canada) between the years 1984 and 1987, was examined and analyzed according to whether the home birth environment had been planned or unplanned. The two groups were compared to each other and to all hospital births according to demographic characteristics of mothers, indicators of prenatal care, and birth outcome. Mothers who had planned their home birth were more likely to be primiparous, attend prenatal classes, obtain regular prenatal care from a physician, and have babies with a higher birth weight than either the unplanned or hospital group. Of particular concern, however, were the subset of unplanned home births who were primiparous. These mothers attended prenatal classes less frequently than any other group, reported the lowest number of physician visits, were youngest, and least likely to be married. In addition their babies averaged the shortest gestational age and the lowest birth weight. Findings in general show that planned and unplanned home births must be considered as heterogeneous groups in any comparison of risk factors and of birth outcome between home and hospital births. Further, within the unplanned group, multiparous women differ from primiparous women. Given the limitations inherent in this and similar studies, the apparent better outcome in the planned home birth group, as measured by birth weight, must be viewed with caution.

  13. Planned and unplanned home births and hospital births in Calgary, Alberta, 1984-87.

    OpenAIRE

    Abernathy, T J; Lentjes, D M

    1989-01-01

    Information collected on all home births in Calgary (Canada) between the years 1984 and 1987, was examined and analyzed according to whether the home birth environment had been planned or unplanned. The two groups were compared to each other and to all hospital births according to demographic characteristics of mothers, indicators of prenatal care, and birth outcome. Mothers who had planned their home birth were more likely to be primiparous, attend prenatal classes, obtain regular prenatal c...

  14. Selected perinatal outcomes associated with planned home births in the United States.

    Science.gov (United States)

    Cheng, Yvonne W; Snowden, Jonathan M; King, Tekoa L; Caughey, Aaron B

    2013-10-01

    More women are planning home birth in the United States, although safety remains unclear. We examined outcomes that were associated with planned home compared with hospital births. We conducted a retrospective cohort study of term singleton live births in 2008 in the United States. Deliveries were categorized by location: hospitals or intended home births. Neonatal outcomes were compared with the use of the χ(2) test and multivariable logistic regression. There were 2,081,753 births that met the study criteria. Of these, 12,039 births (0.58%) were planned home births. More planned home births had 5-minute Apgar score births (0.24%; adjusted odds ratio, 1.87; 95% confidence interval, 1.36-2.58) and neonatal seizure (0.06% vs 0.02%, respectively; adjusted odds ratio, 3.08; 95% confidence interval, 1.44-6.58). Women with planned home birth had fewer interventions, including operative vaginal delivery and labor induction/augmentation. Planned home births were associated with increased neonatal complications but fewer obstetric interventions. The trade-off between maternal preferences and neonatal outcomes should be weighed thoughtfully. Copyright © 2013 Mosby, Inc. All rights reserved.

  15. Planned home birth in the United States and professionalism: a critical assessment.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B; Grünebaum, Amos; Arabin, Birgit; Levene, Malcolm I; Brent, Robert L

    2013-01-01

    Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one's training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a "professional." Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth.The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and

  16. Committee Opinion No. 697: Planned Home Birth.

    Science.gov (United States)

    2017-04-01

    In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

  17. Committee Opinion No. 669: Planned Home Birth.

    Science.gov (United States)

    2016-08-01

    In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

  18. Transfer in planned home births in Sweden--effects on the experience of birth: a nationwide population-based study.

    Science.gov (United States)

    Lindgren, Helena E; Rådestad, Ingela J; Hildingsson, Ingegerd M

    2011-08-01

    More than 10% of all planned home births in high-income countries are completed in the hospital. The aim of this study was to compare the birth experiences among women who planned to give birth at home and completed the birth at home and women who were transferred to hospital during or immediately after the birth. All women in Sweden who had a planned home birth between 1998 and 2005 (n=671) were invited to participate in the study. The women who agreed to participate received one questionnaire for each planned home birth. Mixed methods were used for the analysis. Women who had been transferred during or immediately after the planned home birth had a more negative birth experience in general. In comparison with women who completed the birth at home, the odds ratio for being less satisfied was 13.5, CI 8.1-22.3. Reasons for being dissatisfied related to organizational factors, the way the women were treated or personal ability. Being transferred during a planned home birth negatively affects the birth experience. Treatments as well as organizational factors are considered to be obstacles for a positive birth experience when transfer is needed. Established links between the home birth setting and the hospital might enhance the opportunity for a positive birth experience irrespective of where the birth is completed. Copyright © 2011 Elsevier B.V. All rights reserved.

  19. Ethics and professional responsibility: Essential dimensions of planned home birth.

    Science.gov (United States)

    McCullough, Laurence B; Grünebaum, Amos; Arabin, Birgit; Brent, Robert L; Levene, Malcolm I; Chervenak, Frank A

    2016-06-01

    Planned home birth is a paradigmatic case study of the importance of ethics and professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the professional responsibility model of obstetric ethics, which is based on the professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist's ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman's rights. We then identify the implications of the professional responsibility model for the perinatologist's role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes.

    Science.gov (United States)

    Kennare, Robyn M; Keirse, Marc J N C; Tucker, Graeme R; Chan, Annabelle C

    2010-01-18

    To examine differences in outcomes between planned home births, occurring at home or in hospital, and planned hospital births. Population-based study using South Australian perinatal data on all births and perinatal deaths during the period 1991-2006. Analysis included logistic regression adjusted for predictor variables and standardised perinatal mortality ratios. Perinatal death, intrapartum death, death attributed to intrapartum asphyxia, Apgar score home births accounted for 0.38% of 300,011 births in South Australia. They had a perinatal mortality rate similar to that for planned hospital births (7.9 v 8.2 per 1000 births), but a sevenfold higher risk of intrapartum death (95% CI, 1.53-35.87) and a 27-fold higher risk of death from intrapartum asphyxia (95% CI, 8.02-88.83). Review of perinatal deaths in the planned home births group identified inappropriate inclusion of women with risk factors for home birth and inadequate fetal surveillance during labour. Low Apgar scores were more frequent among planned home births, and use of specialised neonatal care as well as rates of postpartum haemorrhage and severe perineal tears were lower among planned home births, but these differences were not statistically significant. Planned home births had lower caesarean section and instrumental delivery rates, and a seven times lower episiotomy rate than planned hospital births. Perinatal safety of home births may be improved substantially by better adherence to risk assessment, timely transfer to hospital when needed, and closer fetal surveillance.

  1. Planned home births in Czech republic

    OpenAIRE

    Vlhová, Marína

    2007-01-01

    The aim of thesis is to describe general characteristic of women planned home birth in Czech republic. There are described also reasons and motivation to decide to this in thesis. Theoretical part of work is based on history of obstetrics in the world and Czech countries. This part of work analysis current models of birth care and explains humanization of obstetrics and inform about grant and acceptors of birth care. There is summary of places of birth and legal issues in Czech republic nowad...

  2. Committee Opinion No. 669 Summary: Planned Home Birth.

    Science.gov (United States)

    2016-08-01

    In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

  3. Committee Opinion No 697 Summary: Planned Home Birth.

    Science.gov (United States)

    2017-04-01

    In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse-midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

  4. Maternal factors and the probability of a planned home birth

    NARCIS (Netherlands)

    Anthony, S.; Buitendijk, S. E.; Offerhaus, P. M.; Dommelen, P.; Pal-de Bruin, K. M.

    2005-01-01

    OBJECTIVES: In the Netherlands, approximately one-third of births are planned home births, mostly supervised by a midwife. The relationship between maternal demographic factors and home births supervised by midwives was examined. DESIGN: Cross-sectional study. Setting Dutch national perinatal

  5. Maternal factors and the probability of a planned home birth

    NARCIS (Netherlands)

    Anthony, S.; Buitendijk, S.E.; Offerhaus, P.M.; Dommelen, P. van; Pal-de Bruin, K.M. van der

    2005-01-01

    Objectives: In the Netherlands, approximately one-third of births are planned home births, mostly supervised by a midwife. The relationship between maternal demographic factors and home births supervised by midwives was examined. Design: Cross-sectional study. Setting: Dutch national perinatal

  6. Transfer from planned home birth to hospital: improving interprofessional collaboration.

    Science.gov (United States)

    Vedam, Saraswathi; Leeman, Lawrence; Cheyney, Melissa; Fisher, Timothy J; Myers, Susan; Low, Lisa Kane; Ruhl, Catherine

    2014-01-01

    Women's heightened interest in choice of birthplace and increased rates of planned home birth in the United States have been well documented, yet there remains significant public and professional debate about the ethics of planned home birth in jurisdictions where care is not clearly integrated across birth settings. Simultaneously, the quality of interprofessional interactions is recognized as a predictor of health outcomes during obstetric events. When care is transferred across birth settings, confusion and conflict among providers with respect to roles and responsibilities can adversely affect both outcomes and the experience of care for women and newborns. This article reviews findings of recent North American studies that examine provider attitudes toward planned home birth, differing concepts of safety of birthplace as reported by women and providers, and sources of conflict among maternity care providers during transfer from home to hospital. Emerging evidence and clinical exemplars can inform the development of systems for seamless transfer of women and newborns from planned home births to hospital and improve experience and perceptions of safety among families and providers. Three successful models in the United States that have enhanced multidisciplinary cooperation and coordination of care across birth settings are described. Finally, best practice guidelines for roles, communication, and mutual accommodation among all participating providers when transfer occurs are introduced. Research, health professional education, and policy recommendations for incorporation of key components into existing health care systems in the United States are included. © 2014 by the American College of Nurse-Midwives.

  7. Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.

    Science.gov (United States)

    Rainey, Emily; Simonsen, Sara; Stanford, Joseph; Shoaf, Kimberley; Baayd, Jami

    2017-06-01

    The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines. Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines. Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting. Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth. © 2017 Wiley Periodicals, Inc.

  8. Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study.

    Science.gov (United States)

    Blix, Ellen; Huitfeldt, Anette Schaumburg; Øian, Pål; Straume, Bjørn; Kumle, Merethe

    2012-12-01

    The safety of planned home births remains controversial in Western countries. The aim of the present study was to compare outcomes in women who planned, and were selected to, home birth at the onset of labor with women who planned for a hospital birth. Data from 1631 planned home births between 1990 and 2007 were compared with a random sample of 16,310 low-risk women with planned hospital births. The primary outcomes were intrapartum intervention rates and complications. Secondary outcomes were perinatal and neonatal death rates. Primiparas who planned home births had reduced risks for assisted vaginal delivery (OR 0.32; 95% CI 0.20-0.48), epidural analgesia (OR 0.21; CI 0.14-0.33) and dystocia (OR 0.40; CI 0.27-0.59). Multiparas who planned home births had reduced risks for operative vaginal delivery (OR 0.26; CI 0.12-0.56), epidural analgesia (OR 0.08; CI 0.04-0.16), episiotomy (OR 0.48; CI 0.31-0.75), anal sphincter tears (OR 0.29; CI 0.12-0.70), dystocia (OR 0.10; CI 0.06-0.17) and postpartum hemorrhage (OR 0.27; CI 0.17-0.41). We found no differences in cesarean section rate. Perinatal mortality rate was 0.6/1000 (CI 0-3.4) and neonatal mortality rate 0.6/1000 (CI 0-3.4) in the home birth cohort. In the hospital birth cohort, the rates were 0.6/1000 (CI 0.3-1.1) and 0.9/1000 (CI 0.5-1.5) respectively. Planning for home births was associated with reduced risk of interventions and complications. The study is too small to make statistical comparisons of perinatal and neonatal mortality. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. Planned home birth and the association with neonatal hypoxic ischemic encephalopathy.

    Science.gov (United States)

    Wasden, Shane W; Chasen, Stephen T; Perlman, Jeffrey M; Illuzzi, Jessica L; Chervenak, Frank A; Grunebaum, Amos; Lipkind, Heather S

    2017-12-20

    To evaluate the association between planned home birth and neonatal hypoxic ischemic encephalopathy (HIE). This is a case-control study in which a database of neonates who underwent head cooling for HIE at our institution from 2007 to 2011 was linked to New York City (NYC) vital records. Four normal controls per case were then randomly selected from the birth certificate data after matching for year of birth, geographic location, and gestational age. Demographic and obstetric information was obtained from the vital records for both the cases and controls. Location of birth was analyzed as hospital or out of hospital birth. Details from the out of hospital deliveries were reviewed to determine if the delivery was a planned home birth. Maternal and pregnancy characteristics were examined as covariates and potential confounders. Logistic regression was used to determine the odds of HIE by intended location of delivery. Sixty-nine neonates who underwent head cooling for HIE had available vital record data on their births. The 69 cases were matched to 276 normal controls. After adjusting for pregnancy characteristics and mode of delivery, neonates with HIE had a 44.0-fold [95% confidence interval (CI) 1.7-256.4] odds of having delivered out of hospital, whether unplanned or planned. Infants with HIE had a 21.0-fold (95% CI 1.7-256.4) increase in adjusted odds of having had a planned home birth compared to infants without HIE. Out of hospital birth, whether planned home birth or unplanned out of hospital birth, is associated with an increase in the odds of neonatal HIE.

  10. Obstetrician Attitudes, Experience, and Knowledge of Planned Home Birth: An Exploratory Study.

    Science.gov (United States)

    Leone, Jennifer; Mostow, Jackie; Hackney, David; Gokhale, Priyanka; Janata, Jeffrey; Greenfield, Marjorie

    2016-09-01

    The incidence of planned home birth is increasing in the United States. The American College of Obstetricians and Gynecologists acknowledges a woman's right to make an informed choice about place of delivery, including home birth. This exploratory study measures obstetricians' attitudes, experiences, and knowledge about planned home birth, identifies associations between these factors, and compares obstetricians' responses in Ohio to those in Arizona and New Mexico. A survey about attitudes, experiences, and knowledge of planned home birth was distributed to obstetricians in Ohio, Arizona, and New Mexico. Attitude and knowledge scores were calculated for each respondent and used to evaluate associations through linear regression. Attitude and knowledge scores in states that have regulation of direct entry midwives (Arizona and New Mexico) were compared to a state which does not (Ohio). Obstetricians in all three states reported little experience and knowledge of planned home birth and overall negative attitudes. Obstetricians with stronger knowledge did not differ in their attitudes from those with less knowledge. No statistically significant differences were found when comparing attitude and knowledge scores in Ohio to Arizona and New Mexico, but Ohio obstetricians responded most negatively to the attitude questions. Obstetricians have limited knowledge and experience and hold very negative attitudes about planned home birth. Research is necessary to determine: 1) whether negative obstetrician attitudes would be modified by exposure to home birth education and experience, and, 2) whether negative obstetrician beliefs deter safe and timely transfer from home or compromise hospital care for transferred parturients. © 2016 Wiley Periodicals, Inc.

  11. Transfer to hospital in planned home births: a systematic review.

    Science.gov (United States)

    Blix, Ellen; Kumle, Merethe; Kjærgaard, Hanne; Øian, Pål; Lindgren, Helena E

    2014-05-29

    There is concern about the safety of homebirths, especially in women transferred to hospital during or after labour. The scope of transfer in planned home births has not been assessed in a systematic review. This review aimed to describe the proportions and indications for transfer from home to hospital during or after labour in planned home births. The databases Pubmed, Embase, Cinahl, Svemed+, and the Cochrane Library were searched using the MeSH term "home childbirth". Inclusion criteria were as follows: the study population was women who chose planned home birth at the onset of labour; the studies were from Western countries; the birth attendant was an authorised midwife or medical doctor; the studies were published in 1985 or later, with data not older than from 1980; and data on transfer from home to hospital were described. Of the 3366 titles identified, 83 full text articles were screened, and 15 met the inclusion criteria. Two of the authors independently extracted the data. Because of the heterogeneity and lack of robustness across the studies, there were considerable risks for bias if performing meta-analyses. A descriptive presentation of the findings was chosen. Fifteen studies were eligible for inclusion, containing data from 215,257 women. The total proportion of transfer from home to hospital varied from 9.9% to 31.9% across the studies. The most common indication for transfer was labour dystocia, occurring in 5.1% to 9.8% of all women planning for home births. Transfer for indication for foetal distress varied from 1.0% to 3.6%, postpartum haemorrhage from 0% to 0.2% and respiratory problems in the infant from 0.3% to 1.4%. The proportion of emergency transfers varied from 0% to 5.4%. Future studies should report indications for transfer from home to hospital and provide clear definitions of emergency transfers.

  12. Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study.

    Science.gov (United States)

    Lindgren, Helena E; Rådestad, Ingela J; Christensson, Kyllike; Hildingsson, Ingegerd M

    2008-01-01

    The aim of this population-based study was to measure the risk of adverse outcome for mother and child in planned home births in a Swedish population irrespective of where the birth actually occurred, at home or in hospital after transfer. A population-based study using data from the Swedish Medical Birth Register. Sweden 1992-2004. A total of 897 planned home births were compared with a randomly selected group of 11,341 planned hospital births. Prevalence of mortality and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared. During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the home birth group and 0.7 in the hospital group (RR 3.6, 95% CI 0.2-14.7). No cases of emergency complications were found in the home birth group. The risk of having a sphincter rupture was lower in the planned home birth group (RR 0.2, 95% CI 0.0-0.7). The risk of having a cesarean section (RR 0.4, 95% CI 0.2-0.7) or instrumental delivery (RR 0.3, 95% CI 0.2-0.5) was significantly lower in the planned home birth group. In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference was found. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.

  13. Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey.

    Science.gov (United States)

    Fleming, Susan E; Donovan-Batson, Colleen; Burduli, Ekaterina; Barbosa-Leiker, Celestina; Hollins Martin, Caroline J; Martin, Colin R

    2016-10-01

    to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R). a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics ™ ). a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives. the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, women's personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center. total and subscale birth satisfaction scores were positive and high for the overall sample IMPLICATIONS FOR PRACTICE: the BSS and the BSS-R provide a robust tool to quantify women's experiences of childbirth between variables such as birth types, birth settings and providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Effect of Maternal and Pregnancy Risk Factors on Early Neonatal Death in Planned Home Births Delivering at Home.

    Science.gov (United States)

    Bachilova, Sophia; Czuzoj-Shulman, Nicholas; Abenhaim, Haim Arie

    2018-05-01

    The prevalence of home birth in the United States is increasing, although its safety is undetermined. The objective of this study was to investigate the effects of obstetrical risk factors on early neonatal death in planned home births delivering at home. The authors conducted a retrospective 3-year cohort study consisting of planned home births that delivered at home in the United States between 2011 and 2013. The study excluded infants with congenital and chromosomal anomalies and infants born at ≤34 weeks' gestation. Multivariate logistic regression models were used to estimate the adjusted effects of individual obstetrical variables on early neonatal deaths within 7 days of delivery. During the study period, there were 71 704 planned and delivered home births. The overall early neonatal death rate was 1.5 deaths per 1000 planned home births. The risks of early neonatal death were significantly higher in nulliparous births (OR 2.71; 95% CI 1.71-4.31), women with a previous CS (OR 2.62, 95% CI 1.25-5.52), non-vertex presentations (OR 4.27; 95% CI 1.33-13.75), plural births (OR 9.79; 95% CI 4.25-22.57), preterm births (OR 4.68; 95% CI 2.30-9.51), and births at ≥41 weeks of gestation (OR 1.76; 95% CI 1.09-2.84). Early neonatal deaths occur more commonly in certain obstetrical contexts. Patient selection may reduce adverse neonatal outcomes among planned home births. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  15. [Planned home versus planned hospital births: adverse outcomes comparison by reviewing the international literature].

    Science.gov (United States)

    Faucon, C; Brillac, T

    2013-06-01

    To assess the safety of planned home birth compared to hospital birth, in low-risk pregnancies. An international literature review was conducted. Mortality, adverse outcomes and medical interventions were compared. Home birth was not associated with higher mortality rates, but with lower maternal adverse outcomes. Perinatal adverse outcomes are not significantly different at home and in hospital. Medical interventions are more frequent in hospital births. Home birth attended by a well-trained midwife is not associated with increased mortality and morbidity rates, but with less medical interventions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  16. Costs of Planned Home vs. Hospital Birth in British Columbia Attended by Registered Midwives and Physicians.

    Directory of Open Access Journals (Sweden)

    Patricia A Janssen

    Full Text Available Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.Costs for all women planning home birth with a regulated midwife in British Columbia, Canada were compared with those of all women who met eligibility requirements for home birth and were planning to deliver in hospital with a registered midwife, and with a sample of women of similar low risk status planning birth in the hospital with a physician. We calculated costs of physician service billings, midwifery fees, hospital in-patient costs, pharmaceuticals, home birth supplies, and transport. We compared costs among study groups using the Kruskall Wallis test for independent groups.In the first 28 days postpartum, we report a $2,338 average savings per birth among women planning home birth compared to hospital birth with a midwife and $2,541 compared to hospital birth planned with a physician. In longer term outcomes, similar reductions were observed, with cost savings per birth at $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group during the first eight weeks postpartum. During the first year of life, costs for infants of mothers planning home birth were reduced overall. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146. Costs were similarly reduced when findings were stratified by parity.Planned home birth in British Columbia with a registered midwife compared to planned hospital birth is less expensive for our health care system up to 8 weeks postpartum and to one year of age for the infant.

  17. Transfers to hospital in planned home birth in four Nordic countries

    DEFF Research Database (Denmark)

    Blix, Ellen; Kumle, Merethe H; Ingversen, Karen

    2016-01-01

    INTRODUCTION: Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs....../572) of the nulliparas were transferred to hospital, 137 (24.0%) during labor and 49 (8.6%) after the birth. Of the multiparas, 195/2446 (8.0%) were transferred, 118 (4.8%) during labor and 77 (3.2%) after birth. The most common indication for transfers during labor was slow progress. In transfers after birth...

  18. Analysis of 275 planned and 10 unplanned home births.

    Science.gov (United States)

    Schneider, G; Soderstrom, B

    1987-05-01

    The purpose of this study is to describe the outcome in one family practice of planned home births attended by a physician and an experienced birth assistant in a self-selected, but subsequently screened, population over an 11-year period. All but 26 primigravidas were screened out, as were multiple pregnancies and malpresentations. Study parameters included characteristics of the population and maternal and neonatal outcomes. Of 275 intended home confinements, nine were screened out for medical reasons before labour, five in very early labour, and three for failure to progress. Of the 273 who delivered at home, including 10 unplanned births, two were transferred to hospital for postpartum hemorrhage. One neonate was hospitalized for complications. The results of this study, as well as a review of the relevant literature, illustrate that, for a selected population, home birth is a reasonable alternative to hospital.

  19. Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study.

    Science.gov (United States)

    van der Kooy, Jacoba; Birnie, Erwin; Denktas, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2017-06-08

    To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000-2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8-11.0 vs. 13.8% 95% CI 13.6-13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75-0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25-1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.

  20. Being safe: making the decision to have a planned home birth in the United States.

    Science.gov (United States)

    Lothian, Judith A

    2013-01-01

    Although there is evidence that supports the safety of planned home birth for healthy women, less than 1 percent of women in the United States choose to have their baby at home. An ethnographic study of the experience of planned home birth provided rich descriptions of women's experiences planning, preparing for, and having a home birth.This article describes findings related to how women make the decision to have a planned home birth. For these women, being safe emerged as central in making the decision. For them, being safe included four factors: avoiding technological birth interventions, knowing the midwife and the midwife knowing them, feeling comfortable and protected at home, and knowing that backup hospital medical care was accessible if needed.

  1. Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey

    OpenAIRE

    Fleming, Susan E.; Donovan-Batson, Colleen.; Burduli, Ekaterina.; Barbosa-Leiker, Celestina.; Hollins Martin, Caroline J.; Martin, Colin R.

    2016-01-01

    Objective:\\ud to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R).\\ud Study design:\\ud a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected...

  2. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants.

    Directory of Open Access Journals (Sweden)

    Amos Grünebaum

    Full Text Available Over the last decade, planned home births in the United States (US have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status.The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States.This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM, nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board.Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53 than home births attended by certified midwives (NNM: 10.0/10,000; RR 1 and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]. The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2.This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal

  3. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Brent, Robert L; Levene, Malcolm I; Chervenak, Frank A

    2016-01-01

    Over the last decade, planned home births in the United States (US) have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status. The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States. This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life) in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams) without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM), nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board. Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53) than home births attended by certified midwives (NNM: 10.0/10,000; RR 1) and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]). The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2). This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal mortality rates

  4. Analysis of 275 Planned and 10 Unplanned Home Births

    OpenAIRE

    Schneider, Gerd; Soderstrom, Bobbi

    1987-01-01

    The purpose of this study is to describe the outcome in one family practice of planned home births attended by a physician and an experienced birth assistant in a self-selected, but subsequently screened, population over an 11-year period. All but 26 primigravidas were screened out, as were multiple pregnancies and malpresentations. Study parameters included characteristics of the population and maternal and neonatal outcomes. Of 275 intended home confinements, nine were screened out for medi...

  5. Paramedics׳ involvement in planned home birth: A one-year case study.

    Science.gov (United States)

    McLelland, Gayle; McKenna, Lisa; Morgans, Amee; Smith, Karen

    2016-07-01

    to report findings from a study performed prior to the introduction of publicly funded home birth programmes in Victoria, Australia, that investigated the incidence of planned home births attended by paramedics and explored the clinical support they provided as well as the implications for education and practice. retrospective data previously collected via an in-field electronic patient care record (VACIS(®)) was provided by a state-wide ambulance service. Cases were identified via a comprehensive filter, manually screened and analysed using SPSS version 19. over a 12-month period paramedics attended 26 intended home births. Eight women were transported in labour, most for failure to progress. Three called the ambulance service and their pre-organised midwife simultaneously. Paramedics were required for a range of complications including post partum haemorrhage, perineal tears and neonatal resuscitation. Procedures performed for mothers included IV therapy and administering pain relief. For infants, paramedics performed intermittent positive pressure ventilation, endotracheal intubation and external cardiac compression. Of the 23 women transferred to hospital, 22 were transported to hospital within 32minutes. findings highlight that paramedics can provide clinical support, as well as efficient transportation, during perinatal emergencies at planned home births. Cooperative collaboration between ambulance services, privately practising midwives and maternity services to develop guidelines for emergency clinical support and transportation service may minimise risk associated with planned home births. This could also lead to opportunities for interprofessional education between midwives and paramedics. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies.

    Science.gov (United States)

    van der Kooy, Jacoba; Poeran, Jashvant; de Graaf, Johanna P; Birnie, Erwin; Denktasş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2011-11-01

    The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment. The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000-2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat-like analysis) and perfect guideline approach (per-protocol-like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth. Intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71-0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91-1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase). Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

  7. Neonatal mortality in Missouri home births, 1978-84.

    Science.gov (United States)

    Schramm, W F; Barnes, D E; Bakewell, J M

    1987-08-01

    A study was conducted of 4,054 Missouri home births occurring from 1978 through 1984. Of the 3,645 births whose planning status was identified, 3,067 (84 per cent) were planned to be at home. Neonatal mortality was elevated for both planned (17 observed deaths vs 8.59 expected deaths) and unplanned home births (45 observed vs 33.19 expected) compared with physician-attended hospital births. Nearly all of the mortality excess for planned home births occurred in association with lesser trained attendants (12 observed vs 4.42 expected), while for unplanned home births the excess was entirely among infants weighing 1500 grams or more (19 observed vs 3.50 expected). For planned home births attended by physicians, certified nurse-midwives, or Missouri Midwife Association recognized midwives, there was little difference between observed and expected deaths (5 observed vs 3.92 expected). There also was little difference in deaths for unplanned home births weighing less than 1500 grams (26 observed vs 29.69 expected) compared with hospital births. The study provides evidence of the importance of having skilled attendants present at planned home births.

  8. Planned home versus planned hospital births in women at low-risk pregnancy: A systematic review with meta-analysis.

    Science.gov (United States)

    Rossi, A Cristina; Prefumo, Federico

    2018-03-01

    New interest in home birth have recently arisen in women at low risk pregnancy. Maternal and neonatal morbidity of women planning delivery at home has yet to be comprehensively quantified. We aimed to quantify pregnancy outcomes following planned home (PHB) versus planned hospital birth (PHos). We did a systematic review of maternal and neonatal morbidity following planned home (PHB) versus planned hospital birth (PHos). We included prospective, retrospective, cohort and case-control studies of low risk pregnancy outcomes according to planning place of birth, identified from January 2000 to June 2017. We excluded studies in which high-risk pregnancy and composite morbidity were included. Outcomes of interest were: maternal and neonatal morbidity/mortality, medical interventions, and delivery mode. We pooled estimates of the association between outcomes and planning place of birth using meta-analyses. The study protocol is registered with PROSPERO, protocol number CRD42017058016. We included 8 studies of the 4294 records identified, consisting in 14,637 (32.6%) in PHB and 30,177 (67.4%) in PHos group. Spontaneous delivery was significantly higher in PHB than PHos group (OR: 2.075; 95%CI:1.654-2.063) group. Women in PHB group were less likely to undergo cesarean section compared with women in PHos (OR:0.607; 95%CI:0.553-0.667) group. PHB group was less likely to receive medical interventions than PHos group. The risk of fetal dystocia was lower in PHB than PHos group (OR:0.287; 95%CI:0.133-0.618). The risk of post-partum hemorrhage was lower in PHB than PHos group (OR:0.692; 95% CI.0.634-0.755). The two groups were similar with regard to neonatal morbidity and mortality. Births assisted at hospital are more likely to receive medical interventions, fetal monitoring and prompt delivery in case of obstetrical complications. Further studies are needed in order to clarify whether home births are as safe as hospital births. Copyright © 2018 Elsevier B.V. All rights

  9. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants

    OpenAIRE

    Gr?nebaum, Amos; McCullough, Laurence B.; Arabin, Birgit; Brent, Robert L.; Levene, Malcolm I.; Chervenak, Frank A.

    2016-01-01

    Introduction Over the last decade, planned home births in the United States (US) have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status. Purpose The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of...

  10. Outcomes of planned home births with certified professional midwives: large prospective study in North America.

    Science.gov (United States)

    Johnson, Kenneth C; Daviss, Betty-Anne

    2005-06-18

    To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. Prospective cohort study. All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

  11. Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: a retrospective cohort study.

    Science.gov (United States)

    Halfdansdottir, Berglind; Smarason, Alexander Kr; Olafsdottir, Olof A; Hildingsson, Ingegerd; Sveinsdottir, Herdis

    2015-03-01

    At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland. The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables. The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated. This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth. © 2015 Wiley Periodicals, Inc.

  12. Outcomes of planned home births attended by certified nurse-midwives in southeastern Pennsylvania, 1983-2008.

    Science.gov (United States)

    Cox, Kim J; Schlegel, Ruth; Payne, Pat; Teaf, Dusty; Albers, Leah

    2013-01-01

    In this study, we examined the perinatal outcomes of planned home births over a 25-year period (1983-2008) in a group of primarily Amish women (98%) attended by certified nurse-midwives (CNMs) in southeastern Pennsylvania. This was a retrospective, descriptive analysis of data (N = 1836 births) from several CNM practices. Data were abstracted for 25 items, including demographics, labor, and birth. Initially, 2 investigators abstracted 15 records to compare assessments and standardize definitions. Charts were then divided and abstracted individually by one investigator. Several relationships were examined in 2 by 2 tables using the chi-square procedure for the difference in proportions. Maternal and newborn transfers to the hospital were included in the analysis. Of the women who planned home birth for 1836 pregnancies, 1733 of the births occurred at home. Although more than one-third of the women were of high parity (gravida 5-13), rates of postpartum hemorrhage were low (n = 96, 5.5%). There were no maternal deaths. Nearly half of the maternal transfers to the hospital (n = 103, 5.6%) were for ruptured membranes without labor (n = 25, 1.4%) and/or failure to progress (n = 23, 1.3%). The neonatal hospital admission rate also was low (n = 13, 0.75%). Of the 7 (0.4%) early neonatal deaths, all were attributed to lethal congenital anomalies that are common to this population. This study is the first to describe the outcomes of planned home births in a primarily Amish population cared for by CNMs. It also adds to the literature on planned home births in the United States and supports the findings from previous studies that women who have home births attended by CNMs have safety profiles equal to or better than profiles of women who had hospital births in similar populations. © 2013 by the American College of Nurse-Midwives.

  13. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK.

    Science.gov (United States)

    Nove, Andrea; Berrington, Ann; Matthews, Zoë

    2012-11-19

    The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988-2000 inclusive, excluding 'high-risk' pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions. Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost) are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8). The 'home birth' group included women who were transferred to hospital during labour or shortly after birth. Women and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a) whether the same pattern applies to the more life-threatening categories of PPH, and (b) why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.

  14. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study.

    Science.gov (United States)

    Hutton, Eileen K; Reitsma, Angela H; Kaufman, Karyn

    2009-09-01

    Midwives in Ontario, Canada, provide care in the home and hospital and are required to submit data for all births to the Ontario Ministry of Health database. The purpose of this study was to compare maternal and perinatal/neonatal mortality and morbidity and intrapartum intervention rates for women attended by Ontario midwives who planned a home birth compared with similar low-risk women who planned a hospital birth between 2003 and 2006. The database provided outcomes for all women planning a home birth at the onset of labor (n = 6,692) and for a cohort, stratified by parity, of similar low-risk women planning a hospital birth. The rate of perinatal and neonatal mortality was very low (1/1,000) for both groups, and no difference was shown between groups in perinatal and neonatal mortality or serious morbidity (2.4% vs 2.8%; relative risk [RR], 95% confidence intervals [CI]: 0.84 [0.68-1.03]). No maternal deaths were reported. All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section (5.2% vs 8.1%; RR [95% CI]: 0.64 [0.56, 0.73]). Nulliparas were less likely to deliver at home, and had higher rates of ambulance transport from home to hospital than multiparas planning home birth and had rates of intervention and outcomes similar to, or lower than, nulliparas planning hospital births. Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births.

  15. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK

    Directory of Open Access Journals (Sweden)

    Nove Andrea

    2012-11-01

    Full Text Available Abstract Background The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988–2000 inclusive, excluding ‘high-risk’ pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions. Results Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8. The ‘home birth’ group included women who were transferred to hospital during labour or shortly after birth. Conclusions Women and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a whether the same pattern applies to the more life-threatening categories of PPH, and (b why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.

  16. Midwife-assisted planned home birth: an essential component of improving the safety of childbirth in Sub-Saharan Africa.

    Science.gov (United States)

    Dayyabu, Aliyu Labaran; Murtala, Yusuf; Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Levene, Malcolm I; Brent, Robert L; Monni, Giovanni; Sen, Cihat; Makatsariya, Alexander; Chervenak, Frank A

    2018-05-29

    Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.

  17. Staying home to give birth: why women in the United States choose home birth.

    Science.gov (United States)

    Boucher, Debora; Bennett, Catherine; McFarlin, Barbara; Freeze, Rixa

    2009-01-01

    Approximately 1% of American women give birth at home and face substantial obstacles when they make this choice. This study describes the reasons that women in the United States choose home birth. A qualitative descriptive secondary analysis was conducted in a previously collected dataset obtained via an online survey. The sample consisted of 160 women who were US residents and planned a home birth at least once. Content analysis was used to study the responses from women to one essay question: "Why did you choose home birth?" Women who participated in the study were mostly married (91%) and white (87%). The majority (62%) had a college education. Our analysis revealed 508 separate statements about why these women chose home birth. Responses were coded and categorized into 26 common themes. The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.

  18. Home births in the United States, 1990-2009.

    Science.gov (United States)

    MacDorman, Marian F; Mathews, T J; Declercq, Eugene

    2012-01-01

    After 14 years of decline, the percentage of home births rose by 29% from 2004 to 2009, to the point where it is at the highest level since data on this item began to be collected in 1989. The overall increase in home births was driven mostly by a 36% increase for non-Hispanic white women. About 1 out of every 90 births to non-Hispanic white women are now home births. The percentage of home births for non-Hispanic white women was three to five times higher than for any other racial or ethnic group. Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk profile of home compared with hospital births suggests that home birth attendants are selecting low-risk women as candidates for home birth. The increase in the percentage of home births from 2004 to 2009 was widespread and involved selected states from every region of the country. The large variations in the percentage of home births by state may be influenced by differences among states in laws pertaining to births are more prevalent among non-Hispanic white women (7). midwifery practice or out-of-hospital birth (8,9), as well as by differences in the racial and ethnic composition of state populations, as home Studies have suggested that most home births are intentional or planned home births, whereas others are unintentional or unplanned, because of an emergency situation (i.e., precipitous labor, labor complications, or unable to get to the hospital in time) (3,6). Although not representative of all U.S. births (see "Data source and methods"), 87% of home births in a 26-state reporting area (comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of home births were planned (10). Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family

  19. Quality assessment of home births in Denmark

    DEFF Research Database (Denmark)

    Jensen, Sabrina; Colmorn, Lotte B.; Schroll, Anne-Mette

    2017-01-01

    by nulliparous at home. CONCLUSIONS: This study indicates that home births in Denmark are characterized by a high level of safety owing to low rates of perinatal mortality and morbidity. Missing registration on intrapartum transfers and planned versus unplanned home births in the DMBR are, however, major......INTRODUCTION: The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births...... compared with hospital births and to discuss which data are needed to evaluate the safety of home births. METHODS: This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women...

  20. Trends in characteristics of women choosing contraindicated home births.

    Science.gov (United States)

    Zafman, Kelly B; Stone, Joanne L; Factor, Stephanie H

    2018-04-12

    To characterize the American College of Obstetricians and Gynecologists (ACOG) contraindicated home births and the women who are receiving these births in hopes of identifying venues for intervention. The National Center for Health Statistics (NCHS) birth certificate records from 1990 to 2015 were used. "Planned home births" were defined as those births in which birthplace was coded as "residence" and birth attendant was coded as "certified nurse midwife (CNM)" or "other midwife". Contraindicated home births were defined as "planned home births" from 1990 to 2015 that had one or more of the ACOG risk factors for home births, which include vaginal birth after prior cesarean delivery (VBAC), breech presentation and multiple gestations. A review of trends in contraindicated home births from 1990 to 2015 suggests that they are increasing in number (481-1396) and as a percentage of total births (0.01%-0.04%, P95%), which is most frequently initiated in the first trimester. The majority of home births were paid out-of-pocket (65%-69%). The increasing number of contraindicated home births in the United States requires public health action. Home births are likely a matter of choice rather than a lack of resources. It is unclear if women choose home births while knowing the risk or due to a lack of information. Prenatal education about contraindicated home births is possible, as almost all women receive prenatal care.

  1. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases.

    Science.gov (United States)

    de Jonge, A; Geerts, C C; van der Goes, B Y; Mol, B W; Buitendijk, S E; Nijhuis, J G

    2015-04-01

    To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. A nationwide cohort study. The Netherlands. Low-risk women in midwife-led care at the onset of labour. Analysis of national registration data. Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth. Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02‰ for planned home births versus 1.09‰ for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79-1.24; and for parous women, 0.59‰ versus 0.58‰, aOR 1.16, 95% CI 0.87-1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28 days, 3.41‰ versus 3.61‰, aOR 1.05, 95% CI 0.92-1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28 days, 1.36 versus 1.95‰, aOR 0.79, 95% CI 0.66-0.93). We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system. © 2014 Royal College of Obstetricians and Gynaecologists.

  2. Planned home compared with planned hospital births: Mode of delivery and Perinatal mortality rates, an observational study

    NARCIS (Netherlands)

    Kooy, J. (Jacoba); E. Birnie (Erwin); S. Denktaş (Semiha); E.A.P. Steegers (Eric); G.J. Bonsel (Gouke)

    2017-01-01

    textabstractBackground: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Methods: Intervention and perinatal mortality rates were obtained for 679,952 low-risk

  3. Reasons Why Women Choose Home Birth

    Directory of Open Access Journals (Sweden)

    Mary Angelie P. Andrino

    2016-11-01

    Full Text Available Maternal deaths in the Philippines remain high. These deaths are mostly due to the large proportion of home births, complications of pregnancy and delivery, and lack of access to facilities and competently trained staff. Utilizing a descriptive, one-shot survey design, the study aimed to determine the reasons why women in a municipality in Iloilo prefer home birth. The respondents were interviewed using a validated questionnaire. Descriptive statistics were used to analyze and interpret the findings. The study revealed that the proportion of home births progressively declined from 2012 to 2014. Birth being imminent or inevitable is the number one reason that supports home birth. Autonomy, safety, affordability, readily available birthing equipment and supplies, accessibility of birth attendant, remote access by going to the birthing center, lack of transportation, and bad weather conditions also led women to give birth at home. Women from the rural areas of the municipality utilized available resources in the community which prompted the predominance of home deliveries assisted by traditional birth attendants (TBAs and even midwives, who were readily available nearby. This study recommends continuous improvement in existing maternal health interventions and strategies through engagement of women in policy planning, improvement of health service delivery, infrastructural enhancement, better care practices and continuous health education.

  4. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.

    Science.gov (United States)

    de Jonge, Ank; Mesman, Jeanette A J M; Manniën, Judith; Zwart, Joost J; van Dillen, Jeroen; van Roosmalen, Jos

    2013-06-13

    To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Cohort study using a linked dataset. Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. 146 752 low risk women in primary care at the onset of labour. Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%). Low risk

  5. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009.

    Science.gov (United States)

    Cheyney, Melissa; Bovbjerg, Marit; Everson, Courtney; Gordon, Wendy; Hannibal, Darcy; Vedam, Saraswathi

    2014-01-01

    Between 2004 and 2010, the number of home births in the United States rose by 41%, increasing the need for accurate assessment of the safety of planned home birth. This study examines outcomes of planned home births in the United States between 2004 and 2009. We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Data were analyzed according to intended and actual place of birth. Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (home births in the United States, outcomes are congruent with the best available data from population-based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes. © 2014 by the American College of Nurse-Midwives.

  6. Home versus hospital birth--process and outcome.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina

    2010-02-01

    A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States. Obstetricians & Gynecologists, Family Physicians. After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.

  7. Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group.

    Science.gov (United States)

    1996-11-23

    To document the outcome of planned and unplanned births outside hospital. Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. Northern Regional Health Authority area. All 558,691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94. Perinatal death. The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital. The perinatal hazard associated with planned home birth in the few women who exercised this option (unplanned delivery outside hospital.

  8. Facilitating home birth.

    Science.gov (United States)

    Finigan, Valerie; Chadderton, Diane

    2015-06-01

    The birth of a baby is a family experience. However, in the United Kingdom birth often occurs outside the family environment, in hospital. Both home and hospital births have risks and benefits, but research shows that, for most women, it is as safe to give birth at home as it is in hospital. Women report home-birth to be satisfying with lowered risks of intervention and less likelihood of being separated from their family. It is also more cost effective for the National Health Service. Yet, whilst midwives are working hard to promote home birth as an option, it remains controversial. The aim of this paper is to raise awareness of the safety of home birth and the needs of women and midwives when a home birth is chosen. It provides an overview of care required and the role of the midwife in the ensuring care is woman-centred and personalised.

  9. [Home births].

    Science.gov (United States)

    Welffens, K; Kirkpatrick, C; Daelemans, C; Derisbourg, S

    In Belgium, very few women give birth outside the delivery room. In the United Kingdom and in the Netherlands, they are more numerous. Several studies evaluated obstetric and neonatal outcomes of home births compared with hospital births. We selected seven recent and large studies (with cohorts of more than 5.000 women) using PubMed, Science Direct and Cochrane Database of Systematic Reviews. Several questions were examined. Is there any difference in maternal and neonatal outcomes depending on the intended place of birth? Does parity affect outcomes ? What are the characteristics of women who choose to deliver at home ? We conclude that giving birth at home improves obstetric outcomes but is riskier for the baby, especially for the first one. The women delivering at home are mainly white Europeans, between 25 and 35 years old, in a relationship, multiparous and wealthier. In order to avoid this increased risk for the baby while preserving the obstetric advantages, alongside birth centers offer an intermediate solution. They combine the reassuring home-like atmosphere with the safety of the hospital. In Belgium, the first alongside birth center " Le Cocon " (a low technicity unit distinct from the delivery room) offers now this type of alternative place of birth for women in Hôpital Erasme in Brussels.

  10. Quality assessment of home births in Denmark.

    Science.gov (United States)

    Jensen, Sabrina; Colmorn, Lotte B; Schroll, Anne-Mette; Krebs, Lone

    2017-05-01

    The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births compared with hospital births and to discuss which data are needed to evaluate the safety of home births. This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women with uncomplicated pregnancies and no medical interventions during delivery. A total of 6,395 home births and 266,604 hospital births were eligible for analysis. Comparative analyses were performed separately in nulliparous and multiparous women. The outcome measures were neonatal mortality and morbidity. Frequencies of admission to a neonatal intensive care unit and treatment with continuous positive airway pressure were significantly lower in infants born at home than in infants born at a hospital. A slightly, but significantly increased rate of early neonatal death was found among infants delivered by nulliparous at home. This study indicates that home births in Denmark are characterized by a high level of safety owing to low rates of perinatal mortality and morbidity. Missing registration on intrapartum transfers and planned versus unplanned home births in the DMBR are, however, major limitations to the validity and utility of the reported results. Registration of these items of information is necessary to make reasonable assessments of home births in the future. none. not relevant. Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

  11. [Planned home births assisted by nurse midwives: maternal and neonatal transfers].

    Science.gov (United States)

    Koettker, Joyce Green; Brüggemann, Odaléa Maria; Dufloth, Rozany Mucha

    2013-02-01

    The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.

  12. Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study

    NARCIS (Netherlands)

    Hermus, M.A.A.; Hitzert, M.; Boesveld, I.I.; Akker-van Marle, E.M. van den; Dommelen, P. van; Franx, A.; Graaf, J.P. de; Lith, J.M.M. van; Steegers, E.E.; Wiegers, T.A.; Pal-de Bruin, K.K. van der

    2017-01-01

    Objectives To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. Design Prospective cohort study. Setting Low-risk pregnant women

  13. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

    NARCIS (Netherlands)

    de Jonge, J.; Mesman, J.A.J.M.; Manniën, J.; Zwart, J.J.; van Dillen, J.; van Roosmalen, J.

    2013-01-01

    Objectives: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Design: Cohort study

  14. Planned place of birth

    DEFF Research Database (Denmark)

    Overgaard, Charlotte; Coxon, Kirstie; Stewart, Mary

    Title Planned place of birth: issues of choice, access and equity. Outline In Northern European countries, giving birth is generally safe for healthy women with uncomplicated pregnancies, and their babies. However, place of birth can affect women’s outcomes and experiences of birth. Whilst tertiary...... countries, maternity care is provided free to women, through public financing of health care; universal access to care is therefore secured. Nevertheless, different models of care exist, and debates about the appropriateness of providing maternity care in different settings take place in both countries...... in Denmark Coxon K et al: Planned place of birth in England: perceptions of accessing obstetric units, midwife led units and home birth amongst women and their partners. How these papers interrelate These papers draw upon recent research in maternity care, undertaken in Denmark and in England. In both...

  15. Home birth after hospital birth: women's choices and reflections.

    Science.gov (United States)

    Bernhard, Casey; Zielinski, Ruth; Ackerson, Kelly; English, Jessica

    2014-01-01

    The number of US women choosing home birth is increasing. Little is known about women who choose home birth after having experienced hospital birth; therefore, the purpose of this research was to explore reasons why these women choose home birth and their perceptions regarding their birth experiences. Qualitative description was the research design, whereby focus groups were conducted with women who had hospital births and subsequently chose home birth. Five focus groups were conducted (N = 20), recorded, and transcribed verbatim. Qualitative content analysis was undertaken allowing themes to emerge. Five themes emerged from the women's narratives: 1) choices and empowerment: with home birth, women felt they were given real choices rather than perceived choices, giving them feelings of empowerment; 2) interventions and interruptions: women believed things were done that were not helpful to the birth process, and there were interruptions associated with their hospital births; 3) disrespect and dismissal: participants believed that during hospital birth, providers were more focused on the laboring woman's uterus, with some experiencing dismissal from their hospital provider when choosing to birth at home; 4) birth space: giving birth in their own home, surrounded by people they chose, created a peaceful and calm environment; and 5) connection: women felt connected to their providers, families, newborns, and bodies during their home birth. For most participants, dissatisfaction with hospital birth influenced their subsequent decision to choose home birth. Despite experiencing challenges associated with this decision, women expressed satisfaction with their home birth. © 2014 by the American College of Nurse-Midwives.

  16. Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group.

    OpenAIRE

    1996-01-01

    OBJECTIVE: To document the outcome of planned and unplanned births outside hospital. DESIGN: Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. SETTING: Northern Regional Health Authority area. SUBJECTS: All 558,691 registered births to women normally resident in the former Northern Regio...

  17. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK

    OpenAIRE

    Nove, Andrea; Berrington, Ann; Matthews, Zo?

    2012-01-01

    Abstract Background The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, an...

  18. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

    NARCIS (Netherlands)

    de Jonge, A.; Geerts, C.C.; van der Goes, B.Y.; Mol, B.W.; Buitendijk, S.E.; Nijhuis, J.G.

    2015-01-01

    Objective To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. Design A nationwide cohort study. Setting The Netherlands. Population Low-risk women in midwife-led care at the onset of labour. Methods Analysis of national registration data. Main

  19. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

    NARCIS (Netherlands)

    de jonge, A.; Geerts, C. C.; van der Goes, B. Y.; Mol, B. W.; Buitendijk, S. E.; Nijhuis, J. G.

    2015-01-01

    To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. A nationwide cohort study. The Netherlands. Low-risk women in midwife-led care at the onset of labour. Analysis of national registration data. Intrapartum and neonatal death, Apgar scores, and

  20. Factors influencing women's decision to have a home birth in rural Turkey.

    Science.gov (United States)

    Kukulu, Kamile; Oncel, Selma

    2009-02-01

    to ascertain the reasons why mothers choose to have a home birth and the factors that influence these reasons. this cross-sectional study involved 392 women and was conducted between June and September 2003 in a rural setting in Turkey. The data were collected using a questionnaire developed by the authors. The questionnaire included demographic information, obstetric background, the reasons for deciding to give birth at home as well as questions on who encouraged the decision to give birth at home and who assisted in the home births. the decision to have a home birth is related to economic difficulties and the desire to benefit from the assistance of neighbours. Women who had experienced both planned and unplanned home births reported that home birth was unsafe. preliminary information is provided about women having home births that may inform practitioners' educational efforts and future research.

  1. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births

    NARCIS (Netherlands)

    de jonge, A.; van der Goes, B. Y.; Ravelli, A. C. J.; Amelink-Verburg, M. P.; Mol, B. W.; Nijhuis, J. G.; Bennebroek Gravenhorst, J.; Buitendijk, S. E.

    2009-01-01

    OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women

  2. Maternal attitudes towards home birth and their effect on birth outcomes in Iceland: A prospective cohort study.

    Science.gov (United States)

    Halfdansdottir, Berglind; Olafsdottir, Olof A; Hildingsson, Ingegerd; Smarason, Alexander Kr; Sveinsdottir, Herdis

    2016-03-01

    to examine the relationship between attitudes towards home birth and birth outcomes, and whether women's attitudes towards birth and intervention affected this relationship. a prospective cohort study. the study was set in Iceland, a sparsely populated island with harsh terrain, 325,000 inhabitants, high fertility and home birth rates, and less than 5000 births a year. a convenience sample of women who attended antenatal care in Icelandic health care centres, participated in the Childbirth and Health Study in 2009-2011, and expressed consistent attitudes towards home birth (n=809). of the participants, 164 (20.3%) expressed positive attitudes towards choosing home birth and 645 (79.7%) expressed negative attitudes. Women who had a positive attitude towards home birth had significantly more positive attitudes towards birth and more negative attitudes towards intervention than did women who had a negative attitude towards home birth. Of the 340 self-reported low-risk women that answered questionnaires on birth outcomes, 78 (22.9%) had a positive attitude towards home birth and 262 (77.1%) had a negative attitude. Oxytocin augmentation (19.2% (n=15) versus 39.1% (n=100)), epidural analgesia (19.2% (n=15) versus 33.6% (n=88)), and neonatal intensive care unit admission rates (0.0% (n=0) versus 5.0% (n=13)) were significantly lower among women who had a positive attitude towards home birth. Women's attitudes towards birth and intervention affected the relationship between attitudes towards home birth and oxytocin augmentation or epidural analgesia. the beneficial effect of planned home birth on maternal outcome in Iceland may depend to some extent on women's attitudes towards birth and intervention. Efforts to de-stigmatise out-of-hospital birth and de-medicalize women's attitudes towards birth might increase women׳s use of health-appropriate birth services. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Home birth integration into the health care systems of eleven international jurisdictions.

    Science.gov (United States)

    Comeau, Amanda; Hutton, Eileen K; Simioni, Julia; Anvari, Ella; Bowen, Megan; Kruegar, Samantha; Darling, Elizabeth K

    2018-02-13

    The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. © 2018 Wiley Periodicals, Inc.

  4. Home birth in North America: attitudes and practice of US certified nurse-midwives and Canadian registered midwives.

    Science.gov (United States)

    Vedam, Saraswathi; Stoll, Kathrin; Schummers, Laura; Rogers, Judy; Paine, Lisa L

    2014-01-01

    Scope of practice, competencies, and philosophy of maternity practice are similar among midwives in the United States and Canada. However, there are marked differences in intrapartum practice sites between registered midwives (RMs) and certified nurse-midwives (CNMs). This study linked data from 2 national surveys: 1) a 2007 survey of CNM members of the American College of Nurse-Midwives (n = 1893); and 2) the Canadian Birth Place Study of maternity providers, including RM members of the Canadian Association of Midwives (n = 451) to compare the demographics, practice experience, and attitudes to home birth between these 2 types of North American midwives. A Provider Attitudes To Planned Home Birth scale-international (PAPHB-i) was developed for this analysis. Descriptive and bivariate analyses are presented. Educational exposure to planned home birth varied greatly when comparing CNMs and RMs, as did practice patterns regarding continuity of care, primary and gynecologic care, and involvement with research and teaching. Registered midwives were almost 4 times more likely than CNMs to have practiced in the home (99.1% vs 26.0%). Certified nurse-midwives scored significantly lower than RMs on the PAPHB-i scale (36.5 vs 41.0), indicating less favorable attitudes toward home birth overall. Certified nurse-midwives were less confident than RMs in their management skills for home birth practice. Age, exposure to planned home birth during midwifery education, and practice experience in the home setting emerged as significant covariates of attitudes toward home birth. Significantly more RMs and CNMs with home birth experience expressed concerns about disapproval of hospital-based peers, but they were significantly less likely to agree that midwives face other systemic barriers than CNMs with no home birth experience. Differences in favorability toward and confidence with practice during planned home births among CNMs and RMs were predicted associated with differences in

  5. Variation in home-birth rates between midwifery practices in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

    2000-01-01

    Objective: to examine the reasons for the variation in home-birth rates between midwifery practices. method: multi-level analysis of client and midwife associated, case-specific and structural factors in relation to 4420 planned and actual home or hospital births in 42 midwifery practices. Findings:

  6. Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study.

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-04-01

    To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. Prospective cohort study. OUs and planned home births in England. 8180 'higher risk' women in the Birthplace cohort. We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John

  7. Planned and unplanned deliveries at home: implications of a changing ratio.

    Science.gov (United States)

    Murphy, J F; Dauncey, M; Gray, O P; Chalmers, I

    1984-05-12

    The observation that perinatal mortality among babies delivered at home has tended to increase beyond that among babies delivered in consultant obstetric units has caused alarm and prompted recommendations that delivery at home should be further phased out. With data derived from the Cardiff Births Survey the possibility was investigated that this trend might reflect a changing ratio of planned to unplanned domiciliary births. At the beginning of the 1970s deliveries at home that were planned to be so outnumbered those that were not by nearly five to one. By 1979 unplanned deliveries at home outnumbered planned deliveries. The characteristics of the mothers, the health care they received, and the outcome of delivery differed strikingly between planned and unplanned deliveries at home. It is concluded, firstly, that every year the maternity services must try to meet the various needs of about 2000 women in England and Wales who give birth at home without planning to do so; and, secondly, that the heterogeneity of births at home and in hospital will continue to obstruct the search for unbiased estimates of the risks attributable to delivery in specialist obstetric units, general practitioner units, and at home.

  8. Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-01-01

    Objective To explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth. Design Prospective cohort study. Setting OUs and planned home births in England. Population 8180 ‘higher risk’ women in the Birthplace cohort. Methods We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Main outcome measures Composite perinatal outcome measure encompassing ‘intrapartum related mortality and morbidity’ (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. Results The risk of ‘intrapartum related mortality and morbidity’ or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31–0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure ‘intrapartum related mortality and morbidity’ (RR adjusted for parity 1.92, 95% CI 0.97–3.80). Maternal interventions were lower in planned home births. Conclusions The babies of ‘higher risk’ women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between

  9. From institutionalized birth to home birth

    Directory of Open Access Journals (Sweden)

    Clara Fróes de Oliveira Sanfelice

    2014-06-01

    Full Text Available The study aimed to describe the experiences of a group of nurse-midwives from the city of Campinas, SP, Brasil, regarding the transition process from attending institutionalized births to attending home births, in the period 2011 – 2013. The study is of the experience report type; the reflections, perceptions and challenges experienced in this process were collected using the technique of brainstorming. Content analysis, as proposed by Bardin, was used, which yielded four thematic categories: a the hospital experience; b living with obstetric violence; c returning home and d the challenges of home care. It is concluded that attending home births offers greater satisfaction to the nurses, even in the face of various obstacles, as it is possible to offer a care to the woman and new-born which covers both the concept of comprehensiveness and the current scientific recommendations.

  10. A Swedish interview study: parents' assessment of risks in home births.

    Science.gov (United States)

    Lindgren, Helena; Hildingsson, Ingegerd; Rådestad, Ingela

    2006-03-01

    to describe home-birth risk assessment by parents. interviews using a semi-structured interview guide. Data were analysed using a phenomenological approach. independent midwifery practices in Sweden. five couples who had had planned home births. the parents had a fundamental trust that the birth would take place without complications, and they experienced meaningfulness in the event itself. Risks were considered to be part of a complex phenomenon that was not limited to births at home. This attitude seems to be part of a lifestyle that has a bearing on how risks experienced during the birth were handled. Five categories were identified as counterbalancing the risk of possible complications: (1) trust in the woman's ability to give birth; (2) trust in intuition; (3) confidence in the midwife; (4) confidence in the relationship; and (5) physical and intellectual preparation. although the parents were conscious of the risk of complications during childbirth, a fundamental trust in the woman's independent ability to give birth was central to the decision to choose a home birth. Importance was attached to the expected positive effects of having the birth at home. knowledge of parents' assessment can promote an increased understanding of how parents-to-be experience the risks associated with home birth.

  11. Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

    Directory of Open Access Journals (Sweden)

    Amos Grünebaum

    Full Text Available The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC, compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007-2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (<37 weeks and infants weighing under 2500 g. Hospital VBACS were the reference. Women with a planned home birth VBAC had an approximately 10-fold and higher increase in adverse neonatal outcomes when compared to hospital VBACS and hospital repeat cesarean deliveries, a significantly higher incidence and risk of a 5-minute Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4-20.39, p<.0001 and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13-24.29, p<.0001. Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

  12. Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery

    OpenAIRE

    Gr?nebaum, Amos; McCullough, Laurence B.; Arabin, Birgit; Chervenak, Frank A.

    2017-01-01

    The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infa...

  13. Midwifery Provision of Home Birth Services: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-01-01

    The number of women in the United States choosing to give birth at home has risen substantially in the past decade, creating an increased need for understanding of the evidence regarding the provision of midwifery care to women and families considering this option. The safety of home birth has been evaluated in observational studies in several industrialized nations, including the United States. Most studies find that women who are essentially healthy at term with a singleton fetus and give birth at home have positive outcomes and a lower rate of interventions during labor. Although some studies have found increased neonatal morbidity and mortality in newborns born at home when compared to newborns born in a hospital, the absolute numbers reported in both birth sites are very low. The purpose of this clinical bulletin is to review the evidence on provision of care to women and families who plan to give birth at home, including roles and responsibilities, shared decision making, informed consent, and ongoing assessment for birth site selection. © 2015 by the American College of Nurse-Midwives.

  14. Early discharge and home care after unplanned cesarean birth: nursing care time.

    Science.gov (United States)

    Brooten, D; Knapp, H; Borucki, L; Jacobsen, B; Finkler, S; Arnold, L; Mennuti, M

    1996-09-01

    This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. An urban tertiary-care hospital. The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborn was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group.

  15. A reconsideration of home birth in the United States.

    Science.gov (United States)

    Minkoff, Howard; Ecker, Jeffrey

    2013-01-01

    Home births continue to constitute only a small percentage of all deliveries in the United States, in part because of concerns about their safety. While the literature is decidedly mixed in regard to the degree of risk, there are several studies that report that home birth may at times entail a small absolute increase in perinatal risks in circumstances that cannot always be anticipated prior to the onset of labor. While the definition of "small" will vary between individuals, and publications vary in the level of risk they ascribe to birth at home, studies with the least methodological flaws and with adequate power often cite an excess death rate in the range of one per thousand. Home birth is, in that regard, but one example of patients' choices and plans that sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. Our intention in this opinion piece is not to advocate for or against home birth. Rather, we recognize that home birth is but one example of a patient choice that might differ from what a provider feels is in a woman's best interests. In this article we will discuss ethical considerations in such circumstances using home birth as an example. We consider in this article how the ethical principles of respect for autonomy and non-maleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals' evaluation of patient choices. We also consider how in some circumstances, the value and safety added by a physician's participation may outweigh a potentially small increment in absolute risk that might result from a patient's decision to deliver at home because of a perceived physician endorsement. We recognize, however, that doctors and midwives participating in choices they have not recommended, or may even believe will lead to or increase risk for adverse outcomes, presents dilemmas and

  16. Home or hospital birth: a prospective study of midwifery care in the Netherlands.

    OpenAIRE

    Wiegers, T.A.

    1997-01-01

    A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to choose where to give birth, at home or in hospital, assisted by an midwife (or general practitioner). The study showed that for these women the outcome of planned home births is at least as good as that ...

  17. Quality assessment of home births in Denmark

    DEFF Research Database (Denmark)

    Jensen, Sabrina; Colmorn, Lotte B.; Schroll, Anne-Mette

    2017-01-01

    INTRODUCTION: The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births...... compared with hospital births and to discuss which data are needed to evaluate the safety of home births. METHODS: This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women...... with uncomplicated pregnancies and no medical interventions during delivery. A total of 6,395 home births and 266,604 hospital births were eligible for analysis. Comparative analyses were performed separately in nulliparous and multiparous women. The outcome measures were neonatal mortality and morbidity. RESULTS...

  18. Planned and unplanned deliveries at home: implications of a changing ratio.

    OpenAIRE

    Murphy, J F; Dauncey, M; Gray, O P; Chalmers, I

    1984-01-01

    The observation that perinatal mortality among babies delivered at home has tended to increase beyond that among babies delivered in consultant obstetric units has caused alarm and prompted recommendations that delivery at home should be further phased out. With data derived from the Cardiff Births Survey the possibility was investigated that this trend might reflect a changing ratio of planned to unplanned domiciliary births. At the beginning of the 1970s deliveries at home that were planned...

  19. Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Chervenak, Frank A

    2017-01-01

    The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007-2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC) at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (home birth VBAC had an approximately 10-fold and higher increase in adverse neonatal outcomes when compared to hospital VBACS and hospital repeat cesarean deliveries, a significantly higher incidence and risk of a 5-minute Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4-20.39, phome TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

  20. Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study.

    Science.gov (United States)

    Rigg, Elizabeth Christine; Schmied, Virginia; Peters, Kath; Dahlen, Hannah Grace

    2017-03-28

    In Australia the choice to birth at home is not well supported and only 0.4% of women give birth at home with a registered midwife. Recent changes to regulatory requirements for midwives have become more restrictive and there is no insurance product that covers private midwives for intrapartum care at home. Freebirth (planned birth at home with no registered health professional) with an unregulated birth worker who is not a registered midwife or doctor (e.g. Doula, ex-midwife, lay midwife etc.) appears to have increased in Australia. The aim of this study is to explore the reasons why women choose to give birth at home with an unregulated birth worker (UBW) from the perspective of women and UBWs. Nine participants (five women who had UBWs at their birth and four UBWs who had themselves used UBWs in the past for their births) were interviewed in-depth and the data analysed using thematic analysis. Four themes were found: 'A traumatising system', 'An inflexible system'; 'Getting the best of both worlds' and 'Treated with love and respect versus the mechanical arm on the car assembly line'. Women interviewed for this study either experienced or were exposed to mainstream care, which they found traumatising. They were not able to access their preferred birth choices, which caused them to perceive the system as inflexible. They interpreted this as having no choice when choice was important to them. The motivation then became to seek alternative options of care that would more appropriately meet their needs, and help avoid repeated trauma through mainstream care. Women who engaged UBWs viewed them as providing the best of both worlds - this was birthing at home with a knowledgeable person who was unconstrained by rules or regulations and who respected and supported the woman's philosophical view of birth. Women perceived UBWs as not only the best opportunity to achieve a natural birth but also as providing 'a safety net' in case access to emergency care was required.

  1. Investigating the debate of home birth safety: A critical review of cohort studies focusing on selected infant outcomes.

    Science.gov (United States)

    Elder, Heather R; Alio, Amina P; Fisher, Susan G

    2016-07-01

    There is a debate within the medical community regarding the safety of planned home births. The presumption of increased risk of maternal and infant morbidity and mortality at home due to limited access to life-saving interventions is not clearly supported by research. The aim of the present study was to assess strengths and limitations of the methodological approaches of cohort studies that compare home births with hospital births by focusing on selected infant outcomes. Studies were identified that assess the risk for at least one of three infant outcomes (mortality, Apgar score, and admission to the neonatal intensive care unit [NICU]) of home births compared with hospital births. Fifteen cohort studies were included. Two studies of low-risk births and two including higher risk births found home births to be at an increased risk of neonatal mortality. However, mortality is rare in developed nations and may not be the best measure of safety. When studies focused on low-risk pregnancies, planned birth location, and well-trained birth attendants, there was no difference in neonatal morbidity (Apgar score and NICU admission). Many methodological challenges were identified among these studies. This review contributes to the home birth published work by identifying key strengths and limitations that need to be accounted for in the interpretation of study findings and the development of future studies. Based on this review, the key variables that would strengthen future studies are birth attendant identification, documented planned birth location, and specification of the birth risk level. Uniformity of data collection and minimizing missing data are also critical. © 2016 Japan Academy of Nursing Science.

  2. More Than Four Walls: The Meaning of Home in Home Birth Experiences

    Directory of Open Access Journals (Sweden)

    Emily Burns

    2015-04-01

    Full Text Available The “home versus hospital” as places of birth debate has had a long and at times vicious history. From academic literature to media coverage, the two have often been pitted against each other not only as opposing physical spaces, but also as opposing ideologies of birth. The hospital has been heavily critiqued as a site of childbirth since the 1960s, with particular focus on childbirth and medicalisation. The focus of much of the hospital and home birthing research exists on a continuum of medicalisation, safety, risk, agency, and maternal and neonatal health and wellbeing. While the hospital birthing space has been interrogated, a critique of home birthing space has remained largely absent from the social sciences. The research presented in this article unpacks the complex relationship between home birthing women and the spaces in which they birth. Using qualitative data collected with 59 home birthing women in Australia in 2010, between childbearing and the home should not be considered as merely an alternative to hospital births, but rather as an experience that completely renegotiates the home space. Home, for the participants in this study, is a dynamic, changing, and even spiritual element in the childbirth experience, and not simply the building in which it occurs.

  3. The association of birth model with resilience variables and birth experience: Home versus hospital birth.

    Science.gov (United States)

    Handelzalts, Jonathan E; Zacks, Arni; Levy, Sigal

    2016-05-01

    to study home, natural hospital, and medical hospital births, and the association of these birth models to resilience and birth experience. cross-section retrospective design. participants were recruited via an online survey system. Invitations to participate were posted in five different Internet forums for women on maternity leave, from September 2014 to August 2015. the sample comprised 381 post partum healthy women above the age of 20, during their maternity leave. Of the participants: 22% gave birth at home, 32% gave birth naturally in a hospital, and 46% of the participants had a medical birth at the hospital. life Orientation Test Revised (LOT-R), General Self-Efficacy Scale, Sense of Mastery Scale, Childbirth Experience Questionnaire (CEQ). women having had natural births, whether at home or at the hospital, significantly differed from women having had medical births in all aspects of the birth experience, even when controlling for age and optimism. Birth types contributed to between 14% and 24% of the explained variance of the various birth experience aspects. home and natural hospital births were associated with a better childbirth experience. Optimism was identified as a resilience factor, associated both with preference as well as with childbirth experience. physically healthy and resilient women could be encouraged to explore the prospect of home or natural hospital births as a means to have a more positive birth experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Institutional and Cultural Perspectives on Home Birth in Israel

    Science.gov (United States)

    Meroz, Michal (Rosie); Gesser-Edelsburg, Anat

    2015-01-01

    ABSTRACT This study exposes doctors’ and midwives’ perceptions and misperceptions regarding home birth by examining their views on childbirth in general and on risk associated with home births in particular. It relies on an approach of risk communication and an anthropological framework. In a qualitative-constructive study, 19 in-depth interviews were conducted with hospital doctors, hospital midwives, home-birth midwives, and a home-birth obstetrician. Our findings reveal that hospital midwives and doctors suffer from lack of exposure to home births, leading to disagreement regarding norms and risk; it also revealed sexist or patriarchal worldviews. Recommendations include improving communication between home-birth midwives and hospital counterparts; increased exposure of hospital doctors to home birth, creating new protocols in collaboration with home-birth midwives; and establishing a national database of home births. PMID:26937159

  5. Saving Lives at Birth : The Impact of Home Births on Infant Outcomes

    NARCIS (Netherlands)

    Meltem Daysal, N.; Trandafir, M.; van Ewijk, R.

    2012-01-01

    Abstract: Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for

  6. Characteristics associated with intending and achieving a planned home birth in the United Kingdom: An observational study of 515,777 maternities in the North West Thames region, 1988-2000

    OpenAIRE

    Nove, Andrea; Berrington, Ann; Matthews, Zoe

    2011-01-01

    Background and objectives: This study aims to identify factors that have an independent association with planned home birth. It investigates the social, demographic, and obstetric profile of those who choose home birth as compared with those choosing hospital birth. This crucial evidence is lacking in the U.K. context and is needed when comparing pregnancy outcomes of different birth settings. Otherwise, the comparison is problematic because observed differences in incidence of pregnancy outc...

  7. Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Dudenhausen, Joachim; Orosz, Brooke; Chervenak, Frank A

    2017-04-01

    The objective of this study was to evaluate the underlying causes of neonatal mortality (NNM) in midwife-attended home births and compare them to hospital births attended by a midwife or a physician in the United States (US). A retrospective cohort study of the Centers for Disease Control (CDC) linked birth/infant death data set (linked files) for 2008 through 2012 of singleton, term (≥37 weeks) births and normal newborn weights (≥2500 grams). Midwife-attended home births had the highest rate of neonatal deaths [122/95,657 neonatal mortality (NNM) 12.75/10,000; relative risk (RR): 3.6, 95% confidence interval (CI) 3-4.4], followed by hospital physician births (8695/14,447,355 NNM 6.02/10,000; RR: 1.7 95% CI 1.6-1.9) and hospital midwife births (480/1,363,199 NNM 3.52/10,000 RR: 1). Among midwife-assisted home births, underlying causes attributed to labor and delivery caused 39.3% (48/122) of neonatal deaths (RR: 13.4; 95% CI 9-19.9) followed by 29.5% due to congenital anomalies (RR: 2.5; 95% CI 1.8-3.6), and 12.3% due to infections (RR: 4.5; 95% CI 2.5-8.1). There are significantly increased risks of neonatal deaths among midwife-attended home births associated with three underlying causes: labor and delivery issues, infections, and fetal malformations. This analysis of the causes of neonatal death in planned home birth shows that it is consistently riskier for newborns to deliver at home than at the hospital. Physicians, midwives, and other health care providers have a professional responsibility to share information about the clinical benefits and risks of clinical management.

  8. Saving Lives at Birth: The Impact of Home Births on Infant Outcomes

    NARCIS (Netherlands)

    Daysal, N.M.; Trandafir, M.; van Ewijk, R.

    2015-01-01

    Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity in

  9. Prospective study of determinants and costs of home births in Mumbai slums.

    Science.gov (United States)

    Das, Sushmita; Bapat, Ujwala; More, Neena Shah; Chordhekar, Latika; Joshi, Wasundhara; Osrin, David

    2010-07-30

    Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280,000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. We described 1708 (16%) home deliveries among 10,754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. We estimate 32,000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on intensive outreach in vulnerable areas by

  10. Perceptions of risk and risk management among 735 women who opted for a home birth.

    Science.gov (United States)

    Lindgren, Helena E; Rådestad, Ingela J; Christensson, Kyllike; Wally-Bystrom, Kristina; Hildingsson, Ingegerd M

    2010-04-01

    home birth is not included in the Swedish health-care system and the rate for planned home births is less than one in a thousand. The aim of this study was to describe women's perceptions of risk related to childbirth and the strategies for managing these perceived risks. a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis. regarding perceived risks about hospital birth, three categories, all related to loss of autonomy, were identified: (1) being in the hands of strangers; (2) being in the hands of routines and unnecessary interventions; and (3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help: (1) worst-case scenario; and (2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour, and by avoiding discussions concerning risks with health-care professionals. women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health-care professionals. to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so. Copyright 2008 Elsevier Ltd. All rights reserved.

  11. Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.

    Science.gov (United States)

    Hiraizumi, Yoshie; Suzuki, Shunji

    2013-11-01

    It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  12. Where the thread of home births never broke - An interview with Susanne Houd.

    Science.gov (United States)

    Santos, Mário J D S

    2017-04-01

    The option of a planned home birth defies medical and social normativity across countries. In Denmark, despite the dramatic decline in the home birth rates between 1960 and 1980, the right to choose the place of birth was preserved. Little has been produced documenting this process. To present and discuss Susanne Houd's reflection on the history and social dynamics of home birth in Denmark, based in an in-depth interview. This paper is part of wider Short Term Scientific Mission (STSM), in which this interview was framed as oral history. The whole interview transcript is presented, keeping the highest level of detail. In Susanne Houd's testimony, four factors were highlighted as contributing to the decline in the rate of home births from the 1960s to the 1970s: new maternity hospitals; the development of obstetrics as a research-based discipline; the compliance of midwives; and a shift in women's preference, favouring hospital birth. The development of the Danish home birth models was described by Susanne Houd in regard to the processes associated with the medicalisation of childbirth, the role of consumers, and the changing professional dynamics of midwifery. An untold history of home birth in Denmark was documented in this testimony. The Danish childbirth hospitalisation process was presented as the result of a complex interaction of factors. Susanne Houd's reflections reveal how the concerted action of consumers and midwives, framed as a system-challenging praxis, was the cornerstone for the sustainability of home birth models in Denmark. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  13. Trends and characteristics of home vaginal birth after cesarean delivery in the United States and selected States.

    Science.gov (United States)

    Macdorman, Marian F; Declercq, Eugene; Mathews, T J; Stotland, Naomi

    2012-04-01

    To examine trends and characteristics of home vaginal birth after cesarean delivery (VBAC) in the United States and selected states from 1990-2008. Birth certificate data were used to track trends in home and hospital VBACs from 1990-2008. Data on planned home VBAC were analyzed by sociodemographic and medical characteristics for the 25 states reporting this information in 2008 and compared with hospital VBAC data. In 2008, there were approximately 42,000 hospital VBACs and approximately 1,000 home VBACs in the United States, up from 664 in 2003 and 656 in 1990. The percentage of home births that were VBACs increased from less than 1% in 1996 to 4% in 2008, whereas the percentage of hospital births that were VBACs decreased from 3% in 1996 to 1% in 2008. Planned home VBACs had a lower risk profile than hospital VBACs with fewer births to teenagers, unmarried women, or smokers; fewer preterm or low-birth-weight deliveries; and higher maternal education levels. Recent increases in the proportion of U.S. women with a prior cesarean delivery mean that an increasing number of women are faced with the choice and associated risks of either VBAC or repeat cesarean delivery. Recent restrictions in hospital VBAC availability have coincided with increases in home VBACs; however, home VBAC remains rare, with approximately 1,000 occurrences in 2008. II.

  14. Economic implications of home births and birth centers: a structured review.

    Science.gov (United States)

    Henderson, Jane; Petrou, Stavros

    2008-06-01

    It is widely perceived that home births and birth centers may help decrease the costs of maternity care for women with uncomplicated pregnancies and deliveries. This structured review examines the literature relating to the economic implications of home births and birth center care compared with hospital maternity care. The bibliographic databases MEDLINE (from 1950), CINAHL (from 1982), EMBASE (from 1980), and an "in-house" database, Econ2, were searched for relevant English language publications using MeSH and free text terms. Data were extracted with respect to the study design, inclusion criteria, clinical and cost results, and details of what was included in the cost calculations. Eleven studies were included from the United Kingdom, United States, Australia, and Canada. Two studies focused on home births versus other forms and locations of care, whereas nine focused on birth centers versus other forms and locations of care. Resource use was generally lower for women cared for at home and in birth centers due to lower rates of intervention, shorter lengths of stay, or both. However, this fact did not always translate into lower costs because, in the U.K. where many studies were conducted, more midwives of a higher grade were employed to manage the birth centers than are usually employed in maternity units, and because of costs of converting existing facilities into delivery rooms. The quality of much of the literature was poor, although no studies were excluded for this reason. Selection bias was likely to be a problem in those studies not based on randomized controlled trials because, even where birth center eligibility was applied throughout, women who choose to deliver at home or in a birth center are likely to be different in terms of expectations and approach from women choosing to deliver in hospital. This review highlights the paucity of economic literature relating to home births and birth centers. Differences in results between studies may be

  15. Prospective study of determinants and costs of home births in Mumbai slums

    Directory of Open Access Journals (Sweden)

    Das Sushmita

    2010-07-01

    Full Text Available Abstract Background Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. Methods As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. Results We described 1708 (16% home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai, and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. Conclusions We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be

  16. Exceptional deliveries: home births as ethical anomalies in American obstetrics.

    Science.gov (United States)

    Wendland, Claire L

    2013-01-01

    Interest in home birth appears to be growing among American women, and most obstetricians can expect to encounter patients who are considering home birth. In 2011, the American College of Obstetricians and Gynecologists (ACOG) issued an opinion statement intended to guide obstetricians in responding to such patients. In this article, I examine the ACOG statement in light of the historical and contemporary clinical realities surrounding home birth in the United States, an examination guided in part by my own experiences as an obstetrician in home-birth-friendly and home-birth-unfriendly medical milieus. Comparison with other guidelines indicates that ACOG treats home birth as an ethical exception: comparable evidence leads to strikingly different recommendations in the case of home birth and the case of trial of labor following a prior cesarean; and ACOG treats other controversial issues that involve similar ethical questions quite differently. By casting the provision of information as not just the primary but the sole ethical responsibility of the obstetrician, ACOG statement obviates obstetricians' responsibilities to provide appropriate clinical care and to make the safest possible clinical environment for those mothers who choose home birth and for their newborns. What, on its face, seems to be a statement of respect for women's autonomy, implicitly authorizes behaviors that unethically restrain truly autonomous choices. Obstetricians need not attend home births, I argue. Our ethical duties do, however, oblige us (1) to refer clients to skilled clinicians who will attend home birth, (2) to continue respectful antenatal care for those women choosing home birth, (3) to provide appropriate consultation to home birth attendants, and (4) to ensure that transfers of care are smooth and nonpunitive.

  17. United States home births increase 20 percent from 2004 to 2008.

    Science.gov (United States)

    MacDorman, Marian F; Declercq, Eugene; Mathews, T J

    2011-09-01

    After a gradual decline from 1990 to 2004, the percentage of births occurring at home increased from 2004 to 2008 in the United States. The objective of this report was to examine the recent increase in home births and the factors associated with this increase from 2004 to 2008. United States birth certificate data on home births were analyzed by maternal demographic and medical characteristics. In 2008, there were 28,357 home births in the United States. From 2004 to 2008, the percentage of births occurring at home increased by 20 percent from 0.56 percent to 0.67 percent of United States births. This rise was largely driven by a 28 percent increase in the percentage of home births for non-Hispanic white women, for whom more than 1 percent of births occur at home. At the same time, the risk profile for home births has been lowered, with substantial drops in the percentage of home births of infants who are born preterm or at low birthweight, and declines in the percentage of home births that occur to teen and unmarried mothers. Twenty-seven states had statistically significant increases in the percentage of home births from 2004 to 2008; only four states had declines. The 20 percent increase in United States home births from 2004 to 2008 is a notable development that will be of interest to practitioners and policymakers. (BIRTH 38:3 September 2011). © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

  18. Satisfaction with caregivers during labour among low risk women in the Netherlands: the association with planned place of birth and transfer of care during labour.

    Science.gov (United States)

    Geerts, Caroline C; van Dillen, Jeroen; Klomp, Trudy; Lagro-Janssen, Antoine L M; de Jonge, Ank

    2017-07-14

    The caregiver has an important influence on women's birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of  satisfaction with the caregiver' (scale from 1 to 10, with cut-off of below 9) and 'quality of treatment by the caregiver' (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for 'general satisfaction with caregiver' (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for 'general satisfaction' compared to those who planned a hospital birth and who had care transferred (1.44; 1.0-2.1). Furthermore, they significantly more often rated 'quality of treatment by caregiver' high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2-2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Planning home birth is associated to a good experience of quality of care by

  19. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the birthplace national prospective cohort study.

    Science.gov (United States)

    Rowe, Rachel E; Townend, John; Brocklehurst, Peter; Knight, Marian; Macfarlane, Alison; McCourt, Christine; Newburn, Mary; Redshaw, Maggie; Sandall, Jane; Silverton, Louise; Hollowell, Jennifer

    2013-12-05

    In England, there is a policy of offering healthy women with straightforward pregnancies a choice of birth setting. Options may include home or a freestanding midwifery unit (FMU). Transfer rates from these settings are around 20%, and higher for nulliparous women. The duration of transfer is of interest because of the potential for delay in access to specialist care and is also of concern to women. We aimed to estimate the duration of transfer in births planned at home and in FMUs and explore the effects of distance and urgency on duration. This was a secondary analysis of data collected in a national prospective cohort study including 27,842 'low risk' women with singleton, term, 'booked' pregnancies, planning birth in FMUs or at home in England from April 2008 to April 2010. We described transfer duration using the median and interquartile range, for all transfers and those for reasons defined as potentially urgent or non-urgent, and used cumulative distribution curves to compare transfer duration by urgency. We explored the effect of distance for transfers from FMUs and described outcomes in women giving birth within 60 minutes of transfer. The median overall transfer time, from decision to transfer to first OU assessment, was shorter in transfers from home compared with transfers from FMUs (49 vs 60 minutes; p birth for potentially urgent reasons (home 42 minutes, FMU 50 minutes) was 8-10 minutes shorter compared with transfers for non-urgent reasons. In transfers for potentially urgent reasons, the median overall transfer time from FMUs within 20 km of an OU was 47 minutes, increasing to 55 minutes from FMUs 20-40 km away and 61 minutes in more remote FMUs. In women who gave birth within 60 minutes after transfer, adverse neonatal outcomes occurred in 1-2% of transfers. Transfers from home or FMU commonly take up to 60 minutes from decision to transfer, to first assessment in an OU, even for transfers for potentially urgent reasons. Most

  20. Simulation based training in a publicly funded home birth programme in Australia: A qualitative study.

    Science.gov (United States)

    Kumar, Arunaz; Nestel, Debra; Stoyles, Sally; East, Christine; Wallace, Euan M; White, Colleen

    2016-02-01

    Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (midwifery=46, and paramedical=27). There were 110 comments, made by 49 participants. The most frequently identified key learning elements were related to communication (among midwives, paramedical and hospital staff and with the woman's partner), followed by recognising the role of other health care professionals, developing an understanding of the process and the importance of planning ahead. Home birth simulation workshop was found to be a useful tool by staff that provide care to women who are having a planned home birth. Developing clear communication and teamwork were found to be the key learning principles guiding their practice. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  1. The rising home birth trend in America

    OpenAIRE

    Nurlan Aliyev; Chastidy Roldan; Bulent Cakmak

    2015-01-01

    In recent years home birth rates are increased in the whole world, mainly in the United States (US). Between 2004-2012, non-hospital births increasing rate is 89% in the US. Home birth increased especially among the married, non-Hispanic, over 35 years of age, multipar and singleton pregnancies. However the high rate of cesarean birth did not increase in recent years in the US, now it has been stable at 32%. It is reported that the stability of the cesarean rate is related to rising rate of h...

  2. Rural community birth: Maternal and neonatal outcomes for planned community births among rural women in the United States, 2004-2009.

    Science.gov (United States)

    Nethery, Elizabeth; Gordon, Wendy; Bovbjerg, Marit L; Cheyney, Melissa

    2017-11-13

    Approximately 22% of women in the United States live in rural areas with limited access to obstetric care. Despite declines in hospital-based obstetric services in many rural communities, midwifery care at home and in free standing birth centers is available in many rural communities. This study examines maternal and neonatal outcomes among planned home and birth center births attended by midwives, comparing outcomes for rural and nonrural women. Using the Midwives Alliance of North America Statistics Project 2.0 dataset of 18 723 low-risk, planned home, and birth center births, rural women (n = 3737) were compared to nonrural women. Maternal outcomes included mode of delivery (cesarean and instrumental delivery), blood transfusions, severe events, perineal lacerations, or transfer to hospital and a composite (any of the above). The primary neonatal outcome was a composite of early neonatal intensive care unit or hospital admissions (longer than 1 day), and intrapartum or neonatal deaths. Analysis involved multivariable logistic regression, controlling for sociodemographics, antepartum, and intrapartum risk factors. Rural women had different risk profiles relative to nonrural women and reduced risk of adverse maternal and neonatal outcomes in bivariable analyses. However, after adjusting for risk factors and confounders, there were no significant differences for a composite of maternal (adjusted odds ratio [aOR] 1.05 [95% confidence interval {CI} 0.93-1.19]) or neonatal (aOR 1.13 [95% CI 0.87-1.46]) outcomes between rural and nonrural pregnancies. Among this sample of low-risk women who planned midwife-led community births, no increased risk was detected by rural vs nonrural status. © 2017 Wiley Periodicals, Inc.

  3. Outcomes of independent midwifery attended births in birth centres and home births: a retrospective cohort study in Japan.

    Science.gov (United States)

    Kataoka, Yaeko; Eto, Hiromi; Iida, Mariko

    2013-08-01

    the objective of this study was to describe and compare perinatal and neonatal outcomes of women who received care from independent midwives practicing home births and at birth centres in Tokyo. a retrospective cohort study. birth centres and homes serviced by independent midwives in Tokyo. of the 43 eligible independent midwives 19 (44%) (10 assisted birth at birth centres, nine assisted home birth) participated in the study. A total of 5477 women received care during their pregnancy and gave birth assisted by these midwives between 2001 and 2006. researchers conducted a retrospective chart review of women's individual data. Collected data included demographic characteristics, process of pregnancy and perinatal and neonatal outcomes. We also collected data about independent midwives and their practice. of the 5477 women, 83.9% gave birth at birth centres and 16.1% gave birth at home. The average age was 31.7 years old and the majority (70.6%) were multiparas. All women had vaginal spontaneous deliveries, with no vacuum, forceps or caesarean section interventions. No maternal fatalities were reported, nor were breech or multiple births. The average duration of the first and second stages of labour was 14.9 hours for primiparas and 6.2 hours for multiparas. Most women (97.1%) gave birth within 24 hours of membrane rupture. Maternal position during labour varied and family attended birth was common. The average blood loss was 371.3mL, while blood loss over 500mL was 22.6% and over 1000mL was 3.6%. Nearly 60% of women had intact perinea. There were few preterm births (0.6%) and post mature births (1.3%). Infant's average birth weight was 3126g and 0.5% were low-birthweight-infants, while 3.3% had macrosomia. Among primiparas, the birth centre group had more women experiencing an excess of 500mL blood loss compared to the home birth group (27.2% versus 17.6% respectively; RR 1.54; 95%CI 1.10 to 2.16). Multiparas delivering at birth centres were more likely to have a

  4. The politics of home birth in the United States.

    Science.gov (United States)

    Declercq, Eugene

    2012-12-01

    Home birth has emerged as a political issue in several states in the United States, and this essay examines two aspects of home births politics. First, legislative battles over home birth policy do not conform to our typical models of partisan (i.e., Democratic vs Republican) politics, and attempts at advocacy cannot rely on classical strategies of alignment with a dominant party in a state. Second, the debates over home birth have increasingly begun to parallel current partisan battles in their emotion and intensity with the related gridlock and reluctance to consider compromises that are often necessary to achieve policy goals. This essay calls for a greater willingness for all sides to approach home birth less as an ideological mission and more as a health policy challenge to support consumers interested in an integrated system of care. © 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.

  5. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    Science.gov (United States)

    Brocklehurst, Peter; Hardy, Pollyanna; Hollowell, Jennifer; Linsell, Louise; Macfarlane, Alison; McCourt, Christine; Marlow, Neil; Miller, Alison; Newburn, Mary; Petrou, Stavros; Puddicombe, David; Redshaw, Maggie; Rowe, Rachel; Sandall, Jane; Silverton, Louise; Stewart, Mary

    2011-11-23

    To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Prospective cohort study. England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. 64,538 eligible women with a singleton, term (≥37 weeks gestation), and "booked" pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). The results support a policy

  6. Home births and postnatal practices in madagali, North.Eastern ...

    African Journals Online (AJOL)

    Background: Home births are common in resource poor countries and postnatal practices vary from one community to the other. Objective: To determine the proportion of home births, reasons for home delivery, and evaluate postnatal practices in Madagali, north.eastern Nigeria. Materials and Methods: This was a ...

  7. More Than Four Walls: The Meaning of Home in Home Birth Experiences

    OpenAIRE

    Emily Burns

    2015-01-01

    The "home versus hospital" as places of birth debate has had a long and at times vicious history. From academic literature to media coverage, the two have often been pitted against each other not only as opposing physical spaces, but also as opposing ideologies of birth. The hospital has been heavily critiqued as a site of childbirth since the 1960s, with particular focus on childbirth and medicalisation. The focus of much of the hospital and home birthing research exists on a continuum of me...

  8. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: Results of the Dutch Birth Centre study

    NARCIS (Netherlands)

    M.F. Hitzert (Marit); M.A.A. Hermus (Marieke A.A.); Boesveld, I.I.C. (Inge I.C.); A. Franx (Arie); K.M. van der Pal-De Bruin (Karin); E.A.P. Steegers (Eric); Van Den Akker-Van Marle, E.M.E. (Eiske M.E.)

    2017-01-01

    textabstractObjectives To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Design

  9. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

    NARCIS (Netherlands)

    Hitzert, M.; Hermus, M.M.; Boesveld, I.I.; Franx, A.; Pal-de Bruin, K.K. van der; Steegers, E.E.; Akker-van Marle, E.M. van den

    2017-01-01

    Objectives To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Design Economic evaluation

  10. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth : Results of the Dutch Birth Centre study

    NARCIS (Netherlands)

    Hitzert, Marit F.; Hermus, Marieke A. A.; Boesveld, Inge I.C.; Franx, Arie; van der Pal-de Bruin, Karin M.; Steegers, Eric A. P.; Van Den Akker-Van Marle, Eiske M.E.

    2017-01-01

    Objectives To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Design Economic evaluation

  11. Did professional attendance at home births improve early neonatal survival in Indonesia?

    Science.gov (United States)

    Hatt, Laurel; Stanton, Cynthia; Ronsmans, Carine; Makowiecka, Krystyna; Adisasmita, Asri

    2009-07-01

    BACKGROUND Early neonatal mortality has been persistently high in developing countries. Indonesia, with its national policy of home-based, midwife-assisted birth, is an apt context for assessing the effect of home-based professional birth attendance on early neonatal survival. METHODS We pooled four Indonesian Demographic and Health Surveys and used multivariate logistic regression to analyse trends in first-day and early neonatal mortality. We measured the effect of the context of delivery, including place and type of provider, and tested for changes in trend when the 'Midwife in the Village' programme was initiated. RESULTS Reported first-day mortality did not decrease significantly between 1986 and 2002, whereas early neonatal mortality decreased by an average of 3.2% annually. The rate of the decline did not change over the time period, either in 1989 when the Midwife in the Village programme was initiated, or in any year following when uptake of professional care increased. In simple and multivariate analyses, there were no significant differences in first-day or early neonatal death rates comparing home-based births with or without a professional midwife. Early neonatal mortality was higher in public facilities, likely due to selection. Biological determinants (twin births, male sex, short birth interval, previous early neonatal loss) were important for both outcomes. CONCLUSIONS Decreasing newborn death rates in Indonesia are encouraging, but it is not clear that these decreases are associated with greater uptake of professional delivery care at home or in health facilities. This may suggest a need for improved training in immediate newborn care, strengthened emergency referral, and continued support for family planning policies.

  12. Evolution of the Birth Plan

    OpenAIRE

    Kaufman, Tamara

    2007-01-01

    Many birth professionals are discarding the birth plan as an outdated and ineffectual document. This column discusses the past limitations and present uses of the birth plan in an effort to enhance current teaching on how expectant parents can write and use this important document. Encouraging expectant parents to prepare two separate, but corresponding, birth plans—the “Discussion Birth Plan” and the “Hospital Birth Plan”—is proposed. Teaching suggestions and possible implications are explor...

  13. 'Just waiting to be hauled over the coals': home birth midwifery in Ireland.

    Science.gov (United States)

    OBoyle, Colm

    2013-08-01

    to describe the context of Irish home birth midwives' practise experience. ethnography derived from participant observation, unstructured interview and documentary analysis. women and midwives' homes and meeting places in Ireland. 21 self-employed community midwives. choice of place of birth is extremely limited in Ireland. Structural and professional supports for home birth and midwifery are lacking. Home birth midwives highly value midwifery professionalism but are professionally isolated. They promote women's birthing autonomy and choice of place of birth. However, they experience and anticipate negative, even punitive, responses from their own and other professions. This ethnography describes a particularly volatile period in Irish home birth midwifery practice. Irish home birth midwives are professionally isolated which, given wider cultural antagonism to home birth, perfuses their practice with an element of defensiveness. Strong midwifery association is a key pillar of professionalism globally. In Ireland, the lack of a strong professional body undermines autonomous midwifery practice in all settings but particularly in the home. The midwifery philosophy of 'being with woman' appears to run contrary to professionalising discourses where the professional 'knows best'. Contemporary cultural expectations of professionalism such as clinical indemnification and risk averse practice protocols, bring challenges to autonomous midwifery practice. place and context of birth effects not only the woman's birth experience but the midwife's professional autonomy. Without supports for autonomous midwifery, autonomous birthing is under threat. Place of birth effects birth experience and birth quality, not least because it is that context which also influences, for good or ill, midwifery autonomy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. The novice birthing: theorising first-time mothers' experiences of birth at home and in hospital in Australia.

    Science.gov (United States)

    Dahlen, Hannah G; Barclay, Lesley M; Homer, Caroline S E

    2010-02-01

    to explore first-time mothers' experiences of birth at home and in hospital in Australia. a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Sydney, Australia. 19 women were interviewed. Seven women who gave in a public hospital and seven women who gave birth for the first time at home were interviewed and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. three categories emerged from the analysis: preparing for birth, the novice birthing and processing the birth. These women shared a common core experience of seeing that they gave birth as 'novices'. The basic social process running through their experience of birth, regardless of birth setting, was that, as novices, they were all 'reacting to the unknown'. The mediating factors that influenced the birth experiences of these first-time mothers were preparation, choice and control, information and communication, and support. The quality of midwifery care both facilitated and hindered these needs, contributing to the women's perceptions of being 'honoured'. The women who gave birth at home seemed to have more positive birth experiences. identifying the novice status of first-time mothers and understanding the way in which they experience birth better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. It demonstrates how midwives can contribute to positive birth experiences by being aware that first-time mothers, irrespective of birth setting, are essentially reacting to the unknown as they negotiate the experience of birth. Copyright 2008 Elsevier Ltd. All rights reserved.

  15. Home birth or short-stay hospital birth in a low risk population in The Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

    1998-01-01

    In the Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have

  16. Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study

    NARCIS (Netherlands)

    Hitzert, M.; Hermes, M.A.; Scheerhagen, M.; Boesveld, L.C.; Wiegers, T.A.; Akker-van Marle, M.E.; Dommelen, P. van; Pal-de Bruin, K.M. de; Graaf, J.P. de

    2016-01-01

    Objective to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization. Design this study is a cross-sectional study using the ReproQ

  17. Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study.

    NARCIS (Netherlands)

    Hitzert, M.; Hermus, M.; Scheerhagen, M.; Boesveld, I.C.; Wiegers, T.; Akker-van Marle, M.E. van den; Dommelen, P. van; Pal-de Bruin, K.M. van der; Graal, J. P. de

    2016-01-01

    Objective: to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization. Design: this study is a cross-sectional study using the ReproQ

  18. Home births and postnatal practices in Madagali, north-eastern Nigeria.

    Science.gov (United States)

    Bukar, M; Jauro, Y S

    2013-01-01

    Home births are common in resource poor countries and postnatal practices vary from one community to the other. To determine the proportion of home births, reasons for home delivery, and evaluate postnatal practices in Madagali, north-eastern Nigeria. This was a cross-sectional descriptive study of 400 women of reproductive age, who had put to birth in the past 1 year. The study was carried out over a period of 8 weeks from April to June 2010. The multistage method of sampling was used to select respondents. In the first stage, four of the five health districts were chosen randomly, namely, Gulak, Madagali, Sukur, and Duhu. The questionnaires were evenly distributed among the four health districts. In the second stage, from each district, two villages were chosen by simple random sample. In the third stage, two wards were selected in each village by simple random sampling. Of the 400 respondents interviewed, 289 (72.2%) were aged between 20 and 39 years, and most, 374 (93.5%) were married. Only 14 (3.5%) had tertiary education. Most respondents, 224 (56.0%) were farmers and grandmultiparae, 187 (46.7%). A total of 196 (49.0%) women delivered at home, whereas 204 (51.0%) delivered at the hospital. Of the 196 respondents who delivered at home, the bedroom 142 (72.4%), was the preferred place of birth. The most common reason for home birth was short duration of labor in 71 (36.3%) cases. Delivery was conducted by untrained persons in 50, (25.4%), whereas 99 (50.8%) and 31 (15.5%) deliveries were supervised by Traditional Birth Attendants (TBAs) and Midwives/Nurses, respectively. Postpartum, the majority, 235 (58.7%) respondents used sanitary pads to stanch lochia, whereas 140 (35%) used rags. A significant number of births take place in the home and supervised by unskilled persons. Against the backdrop of poor education and low socio-economic status of respondents, perineal hygiene can be adjudged satisfactory. There is the need to increase on the number of hospital

  19. The influences on women who choose publicly-funded home birth in Australia.

    Science.gov (United States)

    Catling, Christine; Dahlen, Hannah; Homer, Caroline S E

    2014-07-01

    to explore the influences on women who chose a publicly-funded home birth in one Australian state. a constructivist grounded theory methodology was used. a publicly-funded home birth service located within a tertiary referral hospital in the southern suburbs of Sydney, Australia. data were collected though semi-structured interviews of 17 women who chose to have a publicly-funded home birth. six main categories emerged from the data. These were feeling independent, strong and confident, doing it my way, protection from hospital related activities, having a safety net, selective listening and telling, and engaging support. The core category was having faith in normal. This linked all the categories and was an overriding attitude towards themselves as women and the process of childbirth. The basic social process was validating the decision to have a home birth. women reported similar influences to other studies when choosing home birth. However, the women in this study were reassured by the publicly-funded system׳s 'safety net' and apparent seamless links with the hospital system. The flexibility of the service to permit women to change their minds to give birth in hospital, and essentially choose their birthplace at any time during pregnancy or labour was also appreciated. women that choose a publicly-funded home birth service describe strong influences that led them to home birth within this model of care. Service managers and health professionals need to acknowledge the importance of place of birth choice for women. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births.

    Science.gov (United States)

    Prata, Ndola; Quaiyum, Md Abdul; Passano, Paige; Bell, Suzanne; Bohl, Daniel D; Hossain, Shahed; Azmi, Ashrafi Jahan; Begum, Mohsina

    2012-12-01

    A 50-fold disparity in maternal mortality exists between high- and low-income countries, and in most contexts, the single most common cause of maternal death is postpartum hemorrhage (PPH). In Bangladesh, as in many other low-income countries, the majority of deliveries are conducted at home by traditional birth attendants (TBAs) or family members. In the absence of skilled birth attendants, training TBAs in the use of misoprostol and an absorbent delivery mat to measure postpartum blood loss may strengthen the ability of TBAs to manage PPH. These complementary interventions were tested in operations research among 77,337 home births in rural Bangladesh. The purpose of this study was to evaluate TBAs' knowledge acquisition, knowledge retention, and changes in attitudes and practices related to PPH management in home births after undergoing training on the use of misoprostol and the blood collection delivery mat. We conclude that the training was highly effective and that the two interventions were safely and correctly used by TBAs at home births. Data on TBA practices indicate adherence to protocol, and 18 months after the interventions were implemented, TBA knowledge retention remained high. This program strengthens the case for community-based use of misoprostol and warrants consideration of this intervention as a potential model for scale-up in settings where complete coverage of skilled birth attendants (SBAs) remains a distant goal. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Keirse, M.J.N.C.; Zee, J. van der; Berghs, G.A.H.

    1996-01-01

    Objective: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. Design: Analysis of prospective data from midwives and their clients.

  2. Trends and characteristics of home births in the United States by race and ethnicity, 1990-2006.

    Science.gov (United States)

    MacDorman, Marian F; Declercq, Eugene; Menacker, Fay

    2011-03-01

    After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006. U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics. From 1990 to 2006, both the number and percentage of home births increased for non-Hispanic white women, but declined for all other race and ethnic groups. In 2006, non-Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non-Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non-Hispanic white women, two-thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or "other" attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations. Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non-Hispanic white women, a larger proportion of non-Hispanic black and Hispanic home births represent unplanned, emergency situations. © 2010, Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc.

  3. Social Network Analysis Applied to a Historical Ethnographic Study Surrounding Home Birth

    Directory of Open Access Journals (Sweden)

    Elena Andina-Diaz

    2018-04-01

    Full Text Available Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health.

  4. Social Network Analysis Applied to a Historical Ethnographic Study Surrounding Home Birth.

    Science.gov (United States)

    Andina-Diaz, Elena; Ovalle-Perandones, Mª Antonia; Ramos-Vidal, Ignacio; Camacho-Morell, Francisca; Siles-Gonzalez, Jose; Marques-Sanchez, Pilar

    2018-04-24

    Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health.

  5. Task shifting Midwifery Support Workers as the second health worker at a home birth in the UK: A qualitative study.

    Science.gov (United States)

    Taylor, Beck; Henshall, Catherine; Goodwin, Laura; Kenyon, Sara

    2018-03-13

    Traditionally two midwives attend home births in the UK. This paper explores the implementation of a new home birth care model where births to low risk women are attended by one midwife and one Midwifery Support Worker (MSW). The study setting was a dedicated home birth service provided by a large UK urban hospital. Seventy-three individuals over 3 years: 13 home birth midwives, 7 MSWs, 7 commissioners (plan and purchase healthcare), 9 managers, 23 community midwives, 14 hospital midwives. Qualitative data were gathered from 56 semi-structured interviews (36 participants), 5 semi-structured focus groups (37 participants) and 38 service documents over a 3 year study period. A rapid analysis approach was taken: data were reduced using structured summary templates, which were entered into a matrix, allowing comparison between participants. Findings were written up directly from the matrix (Hamilton, 2013). The midwife-MSW model for home births was reported to have been implemented successfully in practice, with MSWs working well, and emergencies well-managed. There were challenges in implementation, including: defining the role of MSWs; content and timing of training; providing MSWs with pre-deployment exposure to home birth; sustainability (recruiting and retaining MSWs, and a continuing need to provide two midwife cover for high risk births). The Service had responded to challenges and modified the approach to recruitment, training and deployment. The midwife-MSW model for home birth shows potential for task shifting to release midwife capacity and provide reliable home birth care to low risk women. Some of the challenges tally with observations made in the literature regarding role redesign. Others wishing to introduce a similar model would be advised to explicitly define and communicate the role of MSWs, and to ensure staff and women support it, consider carefully recruitment, content and delivery of training and retention of MSWs and confirm the model is cost

  6. Home births in the Mosvold health ward of KwaZulu | Buchman ...

    African Journals Online (AJOL)

    A community survey was carried out to determine the frequency and the methods of home deliveries in the Mosvold health ward in northern KwaZulu. Of a sample of 210 mothers interviewed 46% had given birth at home, and of these 48% were delivered by traditional birth attendants; 84% gave birth in a kneeling or sitting ...

  7. Maternity care in the Netherlands: the changing home birth rate.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Keirse, M.J.N.C.

    1998-01-01

    In 1965 two-thirds of all births in The Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and fewer than one-third at home. Several factors have influenced that change, including the introduction of short-stay

  8. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004.

    Science.gov (United States)

    Malloy, M H

    2010-09-01

    Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries. United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital 'other' midwife, home certified nurse midwife, home 'other' midwife, and free-standing birth center certified nurse midwife deliveries. For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital 'other' midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home 'other' midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths=614), 0.4 (deaths=7), 1.0 (deaths=14), 1.8 (deaths=75), and 0.6 (deaths=16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45). Deliveries at home attended by CNMs and 'other midwives' were associated with higher risks for mortality than deliveries in-hospital by CNMs.

  9. Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.

    Science.gov (United States)

    Komorowski, Janelle; Andrighetti, Tia; Benton, Melissa

    2017-01-01

    Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting. © 2016 by

  10. Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands.

    Science.gov (United States)

    Bolten, N; de Jonge, A; Zwagerman, E; Zwagerman, P; Klomp, T; Zwart, J J; Geerts, C C

    2016-10-28

    The use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care. Women from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire. Women who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08-1.76, parous women aOR 2.29, 95 % CI 1.21-4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58-0.91, parous women aOR 0.47, 0.33-0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42-0.80, parous women aOR 0.47, 0.37-0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01-3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36-0.82) and more often an intact perineum (aOR 1.65, 1.34-2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml. Women who planned home birth were more likely to give birth spontaneously and had fewer

  11. Are women deciding against home births in low and middle income countries?

    Science.gov (United States)

    Amoako Johnson, Fiifi; Padmadas, Sabu S; Matthews, Zoë

    2013-01-01

    Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings. The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility. There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

  12. Are women deciding against home births in low and middle income countries?

    Directory of Open Access Journals (Sweden)

    Fiifi Amoako Johnson

    Full Text Available Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings.The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility.There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.

  13. What to include in your birth plan

    Science.gov (United States)

    Pregnancy - birth plan ... Birth plans are guides that parents-to-be make to help their health care providers best support them during ... things to consider before you make a birth plan. This is a great time to learn about ...

  14. Trends and characteristics of home and other out-of-hospital births in the United States, 1990-2006.

    Science.gov (United States)

    MacDorman, Marian F; Menacker, Fay; Declercq, Eugene

    2010-03-03

    This report examines trends and characteristics of out-of-hospital and home births in the United States. Descriptive tabulations of data are presented and interpreted. In 2006, there were 38,568 out-of-hospital births in the United States, including 24,970 home births and 10,781 births occurring in a freestanding birthing center. After a gradual decline from 1990 to 2004, the percentage of out-of-hospital births increased by 3% from 0.87% in 2004 to 0.90% in 2005 and 2006. A similar pattern was found for home births. After a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006. Compared with the U.S. average, home birth rates were higher for non-Hispanic white women, married women, women aged 25 and over, and women with several previous children. Home births were less likely than hospital births to be preterm, low birthweight, or multiple deliveries. The percentage of home births was 74% higher in rural counties of less than 100,000 population than in counties with a population size of 100,000 or more. The percentage of home births also varied widely by state; in Vermont and Montana more than 2% of births in 2005-2006 were home births, compared with less than 0.2% in Louisiana and Nebraska. About 61% of home births were delivered by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse midwives, and nearly three-fourths (73%) were delivered by other midwives. Women may choose home birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends and cultural or religious concerns. Lack of transportation in rural areas and cost factors may also play a role.

  15. Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making.

    Science.gov (United States)

    Cox, Kim J; Bovbjerg, Marit L; Cheyney, Melissa; Leeman, Lawrence M

    2015-12-01

    In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased. This study describes the maternal and neonatal outcomes for women who planned a VBAC at home with midwives who were contributing data to the Midwives Alliance of North America Statistics Project 2.0 cohort during the years 2004-2009. Two subsamples were created from the parent cohort: 12,092 multiparous women without a prior cesarean and 1,052 women with a prior cesarean. Descriptive statistics were calculated for maternal and neonatal outcomes for both groups. Sensitivity analyses comparing women with a prior vaginal birth and those who were at the lowest risk with various subgroups in the parent cohort were also conducted. Women with a prior cesarean had a VBAC rate of 87 percent, although transfer rates were higher compared with women without a prior cesarean (18% vs 7%, p history of cesarean (p = 0.015). Although there is a high likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regarding maternal transfer rates and potential for increased risk to the newborn, particularly if uterine rupture occurs in the home setting. © 2015 Wiley Periodicals, Inc.

  16. Formulating evidence-based guidelines for certified nurse-midwives and certified midwives attending home births.

    Science.gov (United States)

    Cook, Elizabeth; Avery, Melissa; Frisvold, Melissa

    2014-01-01

    Implementing national home birth guidelines for certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States may facilitate a common approach to safe home birth practices. Guidelines are evidence-based care recommendations for specified clinical situations that can be modified by individual providers to meet specific client needs. Following a review of home birth guidelines from multiple countries, a set of home birth practices guidelines for US CNMs/CMs was drafted. Fifteen American Midwifery Certification Board, Inc. (AMCB)-certified home birth midwives who participate in the American College of Nurse-Midwives (ACNM) home birth electronic mailing list considered the use of such a document in their practices and reviewed and commented on the guidelines. The proposed guidelines addressed client screening, informed consent, antepartum care, routine intrapartum care, obstetric complications and hospital transports, postpartum care, neonatal care, gynecologic care, primary care, peer reviews, recordkeeping, and physician collaboration. The reviewers had varying assessments as to whether the guidelines reflected international standards and current best evidence. The primary concern expressed was that an adoption of national guidelines could compromise provider autonomy. Incorporation of evidence-based guidelines is an ACNM standard and was recommended by the Home Birth Consensus Summit. Clinical practice guidelines are informed by current evidence and supported by experts in a given discipline. Implementation of guidelines ensures optimal patient care and is becoming increasingly central to reimbursement and to medicolegal support. A set of practice guidelines based on current best evidence and internationally accepted standards was developed and reviewed by an interested group of US CNMs/CMs. Further discussion with home birth midwives and other stakeholders about the development and implementation of home birth guidelines is needed, especially in

  17. Legal regulation of home births

    Directory of Open Access Journals (Sweden)

    Baturan Luka O.

    2015-01-01

    Full Text Available In this paper, authors tried to find efficient legal frame for home births. The main problem is the risk of life and health of a mother and a baby. If a mother wants a home labor, there are no legal obstacles ^for her to take the risk of her own life, after consultation with health-care professionals. However, society is obligated to protect unborn child from irrational behavior of the mother, if she acts against child's best interests. Legal rules were analyzed by methods of neo-institutional economic theory, while the risks of life and health of a mother and a baby were analyzed by medical science methods.

  18. Home birth attendants in low income countries: who are they and what do they do?

    Directory of Open Access Journals (Sweden)

    Garces Ana

    2012-05-01

    Full Text Available Abstract Background Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia. Results A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator. Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.

  19. Home birth attendants in low income countries: who are they and what do they do?

    Science.gov (United States)

    2012-01-01

    Background Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia). Results A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality. PMID:22583622

  20. Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

    Directory of Open Access Journals (Sweden)

    Elizabeth Wickstrom

    2007-10-01

    Full Text Available High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87% occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77% subsequently gave birth at the birthing home, 94 (14% were referred to a regional hospital for delivery, and only 60 (9% delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.

  1. Estimating intrapartum-related perinatal mortality rates for booked home births: when the 'best' available data are not good enough.

    Science.gov (United States)

    Gyte, G; Dodwell, M; Newburn, M; Sandall, J; Macfarlane, A; Bewley, S

    2009-06-01

    To critically appraise a recent study on the safety of home birth (Mori R, Dougherty M, Whittle M. BJOG 2008;115:554) and assess its contribution to the debate about risks and benefits of planned home birth for women at low risk of complications. Critical appraisal of a published paper. England and Wales. Home births from 1994-2003 and all women giving birth in the same time period. Six members of a multidisciplinary group appraised the paper independently. Comments were collated and synthesised. Assessment of: overall methodology; assumptions used in estimating figures; methods used for calculations; conclusions drawn from the results and reliability and consistency of data. Although there were some positive aspects to the study, there were weaknesses in design and an inaccurate estimate of risk. Our evidence suggests that the conclusions drawn did not reflect the results and the methodological weaknesses found in the study rendered both the results and conclusions invalid. On the basis of our critical appraisal, the study does not contribute to the existing evidence about the safety of home birth to inform decision-making or provision of care. The limitations could have been identified by the peer review process and the problems were compounded by an inaccurate press release. Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public. These data should not have been used to inform national guidelines.

  2. Inequality in access to health care in Cambodia: socioeconomically disadvantaged women giving birth at home assisted by unskilled birth attendants.

    Science.gov (United States)

    Hong, Rathavuth; Them, Rathnita

    2015-03-01

    Cambodia faces major challenges in its effort to provide access to health care for all. Although there is a sharp improvement in health and health care in Cambodia, 6 in 10 women still deliver at home assisted by unskilled birth attendants. This practice is associated with higher maternal and infant deaths. This article analyzes the 2005 Cambodia Demographic and Health Survey data to examine the relationship between socioeconomic inequality and deliveries at home assisted by unskilled birth attendants. It is evident that babies in poorer households are significantly more likely to be delivered at home by an unskilled birth attendant than those in wealthier households. Moreover, delivery at home by an unskilled attendant is associated with mothers who have no education, live in a rural residence, and are farmers, and with higher birth order children. Results from this analysis demonstrate that socioeconomic inequality is still a major factor contributing to ill health in Cambodia. © 2011 APJPH.

  3. Nature works best when allowed to run its course. The experience of midwives promoting normal births in a home birth setting.

    Science.gov (United States)

    Aune, Ingvild; Hoston, Mari A; Kolshus, Nora J; Larsen, Christel E G

    2017-07-01

    to gain a deeper understanding of how midwives promote a normal birth in a home birth setting in Norway. a qualitative approach was chosen for data collection. In-depth interviews were conducted with nine midwives working in a home birth setting in different areas in Norway. The transcribed interviews were analysed with the help of systematic text condensation. the analysis generated two main themes: «The midwife's fundamental beliefs» and «Working in line with one's ideology». The midwives had a fundamental belief that childbirth is a normal event that women are able to manage. It is important that this attitude is transferred to the woman in order for her to believe in her own ability to give birth. The midwives in the study were able to work according to their ideology when promoting a normal birth at home. To avoid disturbing the natural birth process was described as an important factor. Also crucial was to approach the work in a patient manner. Staying at home in a safe environment and establishing a close relationship with the midwife also contributed positively to a normal birth. the midwife's attitude is important when trying to promote a normal birth. Patience was seen as essential to avoid interventions. Being in a safe environment with a familiar midwife provides a good foundation for a normal birth. The attitude of the midwives towards normal childbirth ought to be more emphasised, also in the context of maternity wards. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Why women choose to give birth at home: a situational analysis from urban slums of Delhi

    Science.gov (United States)

    Devasenapathy, Niveditha; George, Mathew Sunil; Ghosh Jerath, Suparna; Singh, Archna; Negandhi, Himanshu; Alagh, Gursimran; Shankar, Anuraj H; Zodpey, Sanjay

    2014-01-01

    Objectives Increasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care. Better understanding of the factors influencing home or institutional birth among the urban poor is urgently needed to enhance programme impact. To measure the prevalence of home and institutional births in an urban slum population and identify factors influencing these events. Design Cross-sectional survey using quantitative and qualitative methods. Setting Urban poor settlements in Delhi, India. Participants A house-to-house survey was conducted of all households in three slum clusters in north-east Delhi (n=32 034 individuals). Data on birthing place and sociodemographic characteristics were collected using structured questionnaires (n=6092 households). Detailed information on pregnancy and postnatal care was obtained from women who gave birth in the past 3 months (n=160). Focus group discussions and in-depth interviews were conducted with stakeholders from the community and healthcare facilities. Results Of the 824 women who gave birth in the previous year, 53% (95% CI 49.7 to 56.6) had given birth at home. In adjusted analyses, multiparity, low literacy and migrant status were independently predictive of home births. Fear of hospitals (36%), comfort of home (20.7%) and lack of social support for child care (12.2%) emerged as the primary reasons for home births. Conclusions Home births are frequent among the urban poor. This study highlights the urgent need for improvements in the quality and hospitality of client services and need for family support as the key modifiable factors affecting over two-thirds of this population. These findings should inform the design of strategies to promote institutional births. PMID:24852297

  5. The clientele of traditional birth homes in rural southeastern Nigeria.

    Science.gov (United States)

    Izugbara, C Otutubikey; Ukwayi, J Kinuabeye

    2003-03-01

    Although it is widely documented that traditional birth homes (TBHs) do more than deliver babies, little is known about the other functions in addition to child delivery, which TBHs perform. Drawing on in-depth individual interviews with 13 traditional birth attendants (TBAs) and 147 users of TBHs, we profile the characteristics and health conditions of the clientele of TBHs in four rural communities in southeastern Nigeria. We found that TBHs provide their clients, who are mainly less educated women and girls, health services that range from child delivery, child sex selection, and abortion to family planning and cures for vaginal bleeding. Women are attracted to TBHs because the services are low cost, the women require privacy about their conditions, the TBHs are close by, and the women are confident in the abilities of TBHs. Rural women are bound by poverty, culture, and local values in their choices of services. We assert that health interventions to local people will need to be couched within frameworks that are responsive to their socioeconomic and cultural sensitivities if they are to deliver their expected impact.

  6. An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003.

    Science.gov (United States)

    Mori, R; Dougherty, M; Whittle, M

    2008-04-01

    The objective of this study was to obtain the best estimate of intrapartum-related perinatal mortality (IPPM) rates for booked home births. A population-based cross-sectional study. England and Wales. All births in England and Wales, including home births (intended or unintended) occurring between 1994 and 2003. All IPPM data were derived from the Confidential Enquiry into Maternal and Child Health. Denominators were derived by using unintended home births and transfer rates from home to hospital, from previous studies, with sensitivity analyses. IPPM rates were calculated for the three following subgroups: (a) the completed home birth group, (b) the transferred group and (c) the unintended home birth group. IPPM rate. The overall IPPM rate for England and Wales improved between 1994 and 2003. However, data to obtain a precise estimate of IPPM rate for booked home birth were not available. The average IPPM rate for all births in the study period was 0.79 per 1000 births (95% CI 0.77-0.81), and the estimated IPPM rate for booked home births was 1.28 or 0.74 per 1000 births, depending on the method of calculation (range 0.49-1.47). The IPPM rates for the completed home birth group appeared to be lower throughout the study period compared with the unintended home birth groups. Those women who had booked for a home birth, but later needed to transfer their care for a hospital birth, appeared to have the highest risk of IPPM in the study period. The results of this study need to be interpreted with caution due to inconsistencies occurring in the recorded data. However, the data do highlight two important features. First, they suggest that IPPM rates for home births do not appear to have improved over the study period examined, even though rates did so overall. Second, although the women who booked for home births and had their babies at home seemed to have a generally low IPPM rate, those who required their care to be transferred to hospital did not. Women who book for

  7. The birth of a multicultural funeral home.

    Science.gov (United States)

    van der Pijl, Yvon

    2017-01-01

    In 2014, the Dutch Funeral Organization Yarden started with the participatory preparations for a multicultural funeral home. The project aims at a 24/7 service for the super-diverse population of Amsterdam and beyond. This article gives an ethnographic account of Yarden's efforts to capture cultural diversity. It explores how a multicultural gaze creates a power/knowledge dynamic producing new discourses and shaping new layers of significance. The study then turns into arguing that the birth of the multicultural home is, above all, a cultural, collaborative search leaving (counter-discursive) space for creativity, change, and cultural renewal of all actors involved.

  8. Why women choose to give birth at home: a situational analysis from urban slums of Delhi.

    Science.gov (United States)

    Devasenapathy, Niveditha; George, Mathew Sunil; Ghosh Jerath, Suparna; Singh, Archna; Negandhi, Himanshu; Alagh, Gursimran; Shankar, Anuraj H; Zodpey, Sanjay

    2014-05-22

    Increasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care. Better understanding of the factors influencing home or institutional birth among the urban poor is urgently needed to enhance programme impact. To measure the prevalence of home and institutional births in an urban slum population and identify factors influencing these events. Cross-sectional survey using quantitative and qualitative methods. Urban poor settlements in Delhi, India. A house-to-house survey was conducted of all households in three slum clusters in north-east Delhi (n=32 034 individuals). Data on birthing place and sociodemographic characteristics were collected using structured questionnaires (n=6092 households). Detailed information on pregnancy and postnatal care was obtained from women who gave birth in the past 3 months (n=160). Focus group discussions and in-depth interviews were conducted with stakeholders from the community and healthcare facilities. Of the 824 women who gave birth in the previous year, 53% (95% CI 49.7 to 56.6) had given birth at home. In adjusted analyses, multiparity, low literacy and migrant status were independently predictive of home births. Fear of hospitals (36%), comfort of home (20.7%) and lack of social support for child care (12.2%) emerged as the primary reasons for home births. Home births are frequent among the urban poor. This study highlights the urgent need for improvements in the quality and hospitality of client services and need for family support as the key modifiable factors affecting over two-thirds of this population. These findings should inform the design of strategies to promote institutional births. Published by the BMJ Publishing Group Limited. For permission to use

  9. Home delivery and neonatal mortality in North Carolina.

    Science.gov (United States)

    Burnett, C A; Jones, J A; Rooks, J; Chen, C H; Tyler, C W; Miller, C A

    1980-12-19

    Neonatal mortality examined by place and circumstances of delivery in North Carolina during 1974 through 1976 with attention given to home delivery. Planned home deliveries by lay-midwives resulted in three neonatal deaths per 1,000 live births; planned home deliveries without a lay-midwife, 30 neonatal deaths per 1,000 live births; and unplanned home deliveries, 120 neonatal deaths per 1,000 live births. The women babies were delivered by lay-midwives were screened in county health departments and found to be medically at low risk of complication, despite having demographic characteristics associated with high-risk of neonatal mortality. Conversely, the women delivered at home without known prenatal screening or a trained attendant had low-risk demographic characteristics but experienced a high rate of neonatal mortality. Planning, prenatal screening, and attendant-training were important in differentiating the risk of neonatal mortality in this uncontrolled, observational study.

  10. A comparison of labour and birth experiences of women delivering in a birthing centre and at home in the Netherlands.

    NARCIS (Netherlands)

    Borquez, H.A.; Wiegers, T.A.

    2006-01-01

    OBJECTIVE: to compare the labour and birth experiences of women who delivered at home without complications with the experiences of women who delivered in a birth centre without complications. DESIGN: a descriptive study using postal questionnaires at 1-6 months after birth of a consecutive sample

  11. Birth Planning Values and Decisions: Preliminary Findings.

    Science.gov (United States)

    Townes, Brenda D.; And Others

    The values and processes which underlie people's birth planning decisions were studied via decision theory. Sixty-three married couples including 23 with no children, 33 with one child, and 27 with two children were presented with a large set of personal values related to birth planning decisions. Individuals rated the importance or utility of…

  12. Vacation homes, spatial planning and sustainability

    DEFF Research Database (Denmark)

    Xue, Jin

    2014-01-01

    patterns of vacation homes are highly relevant to environmental sustainability. Unlike the spatial planning for urban areas where the urban environmental problamatique has been highly recognized and theories of sustainable urban development and planning relatively fully developed, vacation home has been...... a missing component in sustainable spatial development and planning both in theories and practice. Moreover, spatial planning for urban areas and vacation homes cannot be separated as they mutually influence each other. Against this background, the paper is concerned with how and to what extent concerns...... on sustainability of vacation homes is integrated into the spatial planning in the Danish context. The lack of ontological and theoretical debates on the environmental sustainability of vacation homes will be reflected upon before investigating the Danish case. A deep realist approach is adopted to explore...

  13. Original article Psychological and socio-demographic correlates of women’s decisions to give birth at home

    Directory of Open Access Journals (Sweden)

    Urszula Domańska

    2014-09-01

    Full Text Available Background Some women decide to give birth at home. They treat their home as a safe place to do so, are against medicalization of natural labour or value activity and autonomy during labour. They are also characterized by good knowledge of their own bodies and about labour in general (including labour at home. Psychological studies have revealed a correlation between labour (including the derived satisfaction and the levels of dispositional optimism, perception of efficacy, and coping with pain. Analysis of the available demographic data shows that the decision to give birth at home is correlated with a certain socio-demographic profile of women. Participants and procedures One hundred thirty five mothers took part in the study. Among them 72 had given birth at home and 63 in a hospital. The following were assumed as important psychological determinants: dispositional optimism, sense of self-efficacy, strategies for coping with pain and their effectiveness. The LOT-R Test, GSES Scale, CSQ Questionnaire as well as a demographic questionnaire were used in the study. Results Women who gave birth at home were characterised by significantly higher levels of optimism and sense of self-efficacy in comparison with the other women. Women giving birth at home reinterpreted the sensations of pain more frequently than the others, who were more likely to catastrophise and pray/hope. The level of conviction about having control over pain was much higher in the experimental group. The relationship between choice of place to give birth and the level of education, marital status, area of residence as well as age is weak. Correlations between the place of birth and income, number of children as well as membership of religious communities are moderate and statistically significant. Conclusions It is important to see and meet the different expectations of the two distinct groups of women. Today’s phenomenon of homebirth requires systematic interdisciplinary

  14. Pulse Oximetry Screening Adapted to a System with Home Births: The Dutch Experience

    Directory of Open Access Journals (Sweden)

    Ilona C. Narayen

    2018-03-01

    Full Text Available Neonatal screening for critical congenital heart defects is proven to be safe, accurate, and cost-effective. The screening has been implemented in many countries across all continents in the world. However, screening for critical congenital heart defects after home births had not been studied widely yet. The Netherlands is known for its unique perinatal care system with a high rate of home births (18% and early discharge after an uncomplicated delivery in hospital. We report a feasibility, accuracy, and acceptability study performed in the Dutch perinatal care system. Screening newborns for critical congenital heart defects using pulse oximetry is feasible after home births and early discharge, and acceptable to mothers. The accuracy of the test is comparable to other early-screening settings, with a moderate sensitivity and high specificity.

  15. Perinatal and infant mortality rates and place of birth in Italy, 1980.

    Science.gov (United States)

    Parazzini, F; La Vecchia, C

    1988-06-01

    In 1980, the ratio of home birth to public hospital perinatal and neonatal mortality rates decreased from Northern to Southern Italy, being inversely related to the proportion of home deliveries and probably reflecting the effect of planned versus unplanned home births. The post neonatal mortality rate in Southern Italy was about four times as high in children born at home (9.5/1,000 live births) than in those delivered in public hospitals (2.6/1,000 live births), probably reflecting differences in the socioeconomic status according to the birthplace selection in various regions.

  16. Home or hospital birth: a prospective study of midwifery care in the Netherlands: research in progress.

    NARCIS (Netherlands)

    Wiegers, T.A.

    1998-01-01

    In 1965 two-thirds of all births in the Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and less than one-third at home. Until the 1970's a woman with an uncomplicated pregnancy was expected to give birth

  17. Plans, preferences or going with the flow: An online exploration of women's views and experiences of birth plans.

    Science.gov (United States)

    Divall, Bernie; Spiby, Helen; Nolan, Mary; Slade, Pauline

    2017-11-01

    To explore women's views of birth plans, and experiences of their completion and use. A qualitative, descriptive study, using Internet-mediated research methods. The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted. Members of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan. Women responded with a range of views and experiences relating to the completion and use of birth plans. The benefits of birth plans were described in terms of communication with healthcare professionals, potentially enhancing awareness of available options, and maintaining a sense of control during labour and birth. However, many respondents believed the idea of 'planning' birth was problematic, and described a reluctance to write a formal plan. The support of healthcare professionals, particularly midwives, was considered essential to the success of both writing and using birth plans. Our findings show a continued debate among women on the benefits and challenges involved in writing and using birth plans, suggesting problems for a 'one size fits all' approach often seen in the use of birth plan templates. In the context of maternity policy supporting women's choice and personalised care, and as a way of acknowledging perceived problems of 'planning' for birth, a flexible approach to birth plans is required, including the consideration of employing alternative nomenclature. Birth plans remain a point of contention in care contexts around the world. Midwives and other healthcare providers play a central role in supporting women to discuss available options, whether or not they decide to complete a formal birth plan. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Does fear of childbirth or family history affect whether pregnant Dutch women prefer a home- or hospital birth?

    Science.gov (United States)

    Sluijs, Anne-Marie; Cleiren, Marc P H D; Scherjon, Sicco A; Wijma, Klaas

    2015-12-01

    It is a generally accepted idea that women who give birth at home are less fearful of giving birth than women who give birth in a hospital. We explored fear of childbirth (FOC) in relation to preferred and actual place of birth. Since the Netherlands has a long history of home birthing, we also examined how the place where a pregnant woman׳s mother or sisters gave birth related to the preferred place of birth. A prospective cohort study. Five midwifery practises in the region Leiden/Haarlem, the Netherlands. 104 low risk nulliparous and parous women. Questionnaires were completed in gestation week 30 (T1) and six weeks post partum (T2). No significant differences were found in antepartum FOC between those who preferred a home or a hospital birth. Women with a strong preference for either home or hospital had lower FOC (mean W-DEQ=60.3) than those with a weak preference (mean W-DEQ=71.0), t (102)=-2.60, p=0.01. The place of birth of close family members predicted a higher chance (OR 3.8) of the same place being preferred by the pregnant woman. Pre- to postpartum FOC increased in women preferring home- but having hospital birth. The idea that FOC is related to the choice of place of birth was not true for this low risk cohort. Women in both preference groups (home and hospital) made their decisions based on negative and positive motivations. Mentally adjusting to a different environment than that preferred, apart from the medical complications, can cause more FOC post partum. The decreasing number of home births in the Netherlands will probably be a self-reinforcing effect, so in future, pregnant women will be less likely to feel supported by their family or society to give birth at home. Special attention should be given to the psychological condition of women who were referred to a place of birth and caregiver they did not prefer, by means of evaluation of the delivery and being alert to anxiety or other stress symptoms after childbirth. These women have higher

  19. Birth planning in Cuba: a basic human right.

    Science.gov (United States)

    Swanson, J M

    1981-01-01

    This paper reports on the development of birth planning in Cuba and strategies that are relevant to nurses in the communities of Cuba. Cuba reduced its crude birth rate by 40% from 1964-75 without formal family planning programs and resources. By 1975, Cuba had achieved the lowest birth rate in Latin America (21/1000) except Barbados (19/1000). By 1978, Cuba's crude birth rate declined to a low of 15.3/1000. The demographic transition in Cuba has been a process of equalization by: 1) community participation to ensure basic human rights for everyone, 2) increasing the status of women while providing child care centers, 3) providing equal availability of health care services including contraceptive services, sterilization, and abortion, and 4) focusing on individual birth choice, not on limiting population growth. Emphasis in Cuba for reducing fertility has been put on literacy, education, and infant mortality. The illiteracy rate in 1961 decreased from 20% to 4%. Infant mortality decreased from 38.8/1000 live births in 1970 to 22.3/1000 in 1978. 1/3 of Cuban women were participating fully in the labor force in 1978. Polyclinics have been established as preventive care medical centers throughout Cuba and health care is free. Family planning options are integrated into routine primary health care at polyclinics and assure equal access to the total Cuban population. Abortion is freely available and increased to 61/1000 in 1976. The implications for nursing are that: 1) the traditional work of nurses places them in a key position to help extend basic human rights beyond current levels, 2) nurses can initiate discussions of birth planning with women and men in a variety of settings, and 3) nurses can increase case-finding related to birth planning needs both in health care classes or within established groups in the community.

  20. Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth

    DEFF Research Database (Denmark)

    Edqvist, Malin; Blix, Ellen; Hegaard, Hanne K

    2016-01-01

    at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries. METHODS: A population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth...... by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data. RESULTS: Two thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included.......26-1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10-0.54). CONCLUSION: A low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum...

  1. Confronting Rhetorical Disability: A Critical Analysis of Women's Birth Plans

    Science.gov (United States)

    Owens, Kim Hensley

    2009-01-01

    Through its analysis of birth plans, documents some women create to guide their birth attendants' actions during hospital births, this article reveals the rhetorical complexity of childbirth and analyzes women's attempts to harness birth plans as tools of resistance and self-education. Asserting that technologies can both silence and give voice,…

  2. Transfer to hospital in planned home births

    DEFF Research Database (Denmark)

    Blix, Ellen; Kumle, Merethe; Kjærgaard, Hanne

    2014-01-01

    was chosen. RESULTS: Fifteen studies were eligible for inclusion, containing data from 215,257 women. The total proportion of transfer from home to hospital varied from 9.9% to 31.9% across the studies. The most common indication for transfer was labour dystocia, occurring in 5.1% to 9.8% of all women...

  3. Home births in the context of free health care: The case of Kaya health district in Burkina Faso.

    Science.gov (United States)

    Kouanda, Seni; Bado, Aristide; Meda, Ivlabèhiré Bertrand; Yameogo, Gisèle S; Coulibaly, Abou; Haddad, Slim

    2016-11-01

    To identify the factors associated with home births in the Kaya health district in Burkina Faso, where child delivery was free of charge between 2007 and 2011. Both qualitative and quantitative data were collected from the Kaya Health and Demographic Surveillance System (Kaya HDSS) among women who delivered at home or in a health facility between January 2008 and December 2010. Multilevel logistic regression was applied to quantitative data, while the qualitative data were analyzed thematically based on emerging themes, subthemes, and patterns across group and individual cases. The findings indicate that 12% (n=311) of childbirths occurred at home (n=2560). Key factors associated with home birth were age, distance from the household to the primary health center, and prenatal visits. The qualitative analysis showed that immediate child delivery, previous experience of giving birth at home, negative experiences with health centers, fear of cesarean delivery, and lack of transport are key predictors of home births. Though relevant, addressing the financial barrier to health care is not enough. Additional measures are necessary to further reduce the rate of home births. Copyright © 2016. Published by Elsevier Ireland Ltd.

  4. Birth Settings and the Validation of Neonatal Seizures Recorded in Birth Certificates Compared to Medicaid Claims and Hospital Discharge Abstracts Among Live Births in South Carolina, 1996-2013.

    Science.gov (United States)

    Li, Qing; Jenkins, Dorothea D; Kinsman, Stephen L

    2017-05-01

    Objective Neonatal seizures in the first 28 days of life often reflect underlying brain injury or abnormalities, and measure the quality of perinatal care in out-of-hospital births. Using the 2003 revision of birth certificates only, three studies reported more neonatal seizures recorded among home births ​or planned out-of-hospital births compared to hospital births. However, the validity of recording neonatal seizures or serious neurologic dysfunction across birth settings in birth certificates has not been evaluated. We aimed to validate seizure recording in birth certificates across birth settings using multiple datasets. Methods We examined checkbox items "seizures" and "seizure or serious neurologic dysfunction" in the 1989 and 2003 revisions of birth certificates in South Carolina from 1996 to 2013. Gold standards were ICD-9-CM codes 779.0, 345.X, and 780.3 in either hospital discharge abstracts or Medicaid encounters jointly. Results Sensitivity, positive predictive value, false positive rate, and the kappa statistic of neonatal seizures recording were 7%, 66%, 34%, and 0.12 for the 2003 revision of birth certificates in 547,177 hospital births from 2004 to 2013 and 5%, 33%, 67%, and 0.09 for the 1998 revision in 396,776 hospital births from 1996 to 2003, and 0, 0, 100%, -0.002 among 660 intended home births from 2004 to 2013 and 920 home births from 1996 to 2003, respectively. Conclusions for Practice Despite slight improvement across revisions, South Carolina birth certificates under-reported or falsely reported seizures among hospital births and especially home births. Birth certificates alone should not be used to measure neonatal seizures or serious neurologic dysfunction.

  5. 'Reacting to the unknown': experiencing the first birth at home or in hospital in Australia.

    Science.gov (United States)

    Dahlen, Hannah G; Barclay, Lesley; Homer, Caroline S E

    2010-08-01

    to explore the experiences of a small group of first-time mothers giving birth at home or in hospital. a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Sydney, Australia. 19 women were interviewed. Seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were interviewed, and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. these women shared common experiences of giving birth as 'novices'. Regardless of birth setting, they were all 'reacting to the unknown'. As they entered labour, the women chose different levels of responsibility for their birth. They also readjusted their expectations when the reality of labour occurred, reacted to the 'force' of labour, and connected or disconnected from the labour and eventually the baby. knowing that first-time mothers, irrespective of birth setting, are essentially 'reacting to the unknown' as they negotiate the experience of birth, could alter the way in which care is provided and increase the sensitivity of midwives to women's needs. Most importantly, midwives need to be aware of the need to help women adjust their expectations during labour and birth. Identifying the 'novice' status of first-time mothers also better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. Crown Copyright 2008. Published by Elsevier Ltd. All rights reserved.

  6. Prevention of Postpartum Hemorrhage: Options for Home Births in ...

    African Journals Online (AJOL)

    This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions. In rural Tigray, Ethiopia, traditional birth attendants (TBAs) in intervention areas were trained to administer ...

  7. Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands.

    Directory of Open Access Journals (Sweden)

    Ank de Jonge

    Full Text Available To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands.Data were combined from the Birthplace study in England (from April 2008 to April 2010 and the National Perinatal Register in the Netherlands (2009. Low risk women in England planning birth at home (16,470 or in freestanding midwifery units (11,133 were compared with Dutch women with planned home births (40,468. Low risk English women with births planned in alongside midwifery units (16,418 or obstetric units (19,096 were compared with Dutch women with planned midwife-led hospital births (37,887.CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj OR 1.89 (95% CI 1.64 to 2.18 and 3.66 (2.90 to 4.63 respectively. Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups.When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands.

  8. The tyranny of distance: maternity waiting homes and access to birthing facilities in rural Timor-Leste.

    Science.gov (United States)

    Wild, Kayli; Barclay, Lesley; Kelly, Paul; Martins, Nelson

    2012-02-01

    To examine the impact of maternity waiting homes on the use of facility-based birthing services for women in two remote districts of Timor-Leste. A before-and-after study design was used to compare the number of facility-based births in women who lived at different distances (0-5, 6-25, 26-50 and > 50 km) from the health centre before and after implementation of maternity waiting homes. Routine data were collected from health centre records at the end of 2007; they included 249 births in Same, Manufahi district, and 1986 births in Lospalos, Lautem district. Population data were used to estimate the percentage of women in each distance category who were accessing facility-based care. Most facility-based births in Same (80%) and Lospalos (62%) were among women who lived within 5 km of the health centre. There was no significant increase in the number of facility-based births among women in more remote areas following implementation of the maternity waiting homes. The percentage of births in the population that occurred in a health facility was low for both Manufahi district (9%) and Lautem district (17%), and use decreased markedly as distance between a woman's residence and the health facilities increased. The maternity waiting homes in Timor-Leste did not improve access to facility-based delivery for women in remote areas. The methods for distance analysis presented in this paper provide a framework that could be used by other countries seeking to evaluate maternity waiting homes.

  9. Transfer from home to hospital: what is its effect on the experience of childbirth?

    Science.gov (United States)

    Wiegers, T A; van der Zee, J; Keirse, M J

    1998-03-01

    In the Netherlands women with low-risk pregnancies are free to choose where to give birth, at home or in hospital, attended by an independent midwife or general practitioner. On average one of five women who remains in the care of a midwife at the onset of labor will be referred to an obstetrician during or shortly after childbirth. If women had planned to give birth at home, they would then have to be transferred to the hospital. Postal questionnaires were sent to 2301 pregnant women before and after birth to measure the experience of childbirth, appropriateness of the chosen place of birth, satisfaction with the birth, midwife's care, and first days postpartum of women planning to give birth at home or in hospital. The response rate for both questionnaires was 89.3 percent. Of 745 nulliparous women and 895 multiparous women, 39.3 and 10.3 percent, respectively, experienced referral to an obstetrician during labor. Of these women, the ones who wanted to give birth at home but were transferred to hospital because of the referral were as positive about the birth, early puerperium, and attendance of the midwife as the women who wanted to give birth in hospital. Our research showed, contrary to expectations, that an unplanned transfer from a planned home birth to hospital has little influence on the experience of childbirth.

  10. Home births in the Netherlands: midwifery-related factors of influence.

    NARCIS (Netherlands)

    Jabaaij, L.; Meijer, W.

    1996-01-01

    Objective: Identification of midwifery-related factors influencing the varied percentage of home births in the practices of Dutch midwives. Design: Cross-sectional study. Setting: Independent midwifery practices in the Netherlands. Participants: 115 independent midwives. Measurements: Recording of

  11. Cost analysis of the Dutch obstetric system: low-risk nulliparous women preferring home or short-stay hospital birth--a prospective non-randomised controlled study.

    Science.gov (United States)

    Hendrix, Marijke Jc; Evers, Silvia Maa; Basten, Marloes Cm; Nijhuis, Jan G; Severens, Johan L

    2009-11-19

    In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. This study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis. In the group of home births, the total societal costs associated with giving birth at home were euro3,695 (per birth), compared with euro3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (euro138.38 vs. euro87.94, -50 (2.5-97.5 percentile range (PR)-76;-25), p home' (euro1,551.69 vs. euro1,240.69, -311 (PR -485; -150), p home birth are euro4,364 per birth, and euro4,541 per birth for short-stay hospital births. The total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.

  12. Home birth and hospital birth trends in Bo, Sierra Leone.

    Science.gov (United States)

    Jacobsen, Kathryn H; Abdirahman, Hafsa A; Ansumana, Rashid; Bockarie, Alfred S; Bangura, Umaru; Jimmy, David Henry; Malanoski, Anthony P; Sundufu, Abu James; Stenger, David A

    2012-06-01

    As of April 2010, all maternity care at government healthcare facilities in Sierra Leone is provided at no cost to patients. In late 2010, we conducted a community health census of 18 sections of the city of Bo (selected via randomized cluster sampling from 68 total sections). Among the 3421 women with a history of pregnancy who participated in the study, older women most often reported having a history of both home and hospital deliveries, while younger women showed a preference for hospital births. The proportion of lastborn children delivered at a healthcare facility increased from 71.8% of offspring 10-14 years old to 81.1% of those one to nine years old and 87.3% of infants born after April 2010. These findings suggest that the new maternal healthcare initiative has accelerated an existing trend toward a preference for healthcare facility births, at least in some urban parts of Sierra Leone. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Prevalence, reasons and predictors for home births among pregnant women attending antenatal care in Birnin Kudu, North-west Nigeria.

    Science.gov (United States)

    Ashimi, Adewale Olufemi; Amole, Taiwo Gboluwaga

    2015-10-01

    To determine the prevalence, reasons and predictors for home birth in a rural community. Descriptive cross sectional study which utilised a pretested interviewer administered semi-structured questionnaire to assess the place of delivery in their last childbirth among 410 pregnant women attending antenatal care in Birnin Kudu, Nigeria. Logistic regression analysis was used to assess the relative effect of determinants. Of the 410 women, 248 (60.5%) delivered at home in their last childbirth. Self reported reasons: Home birth was opted for because of: lack of transportation 113 (45.6%), onset of labour was at night 104 (41.9 %), preferred birthing position 72 (29.0%), tradition 60 (24.2%), fear of surgery 42 (16.9%) and poor attitude of health workers 32 (12.9%). The odds of giving birth at home was 3.88 times higher in women with informal education (adjusted OR 3.88; 95% CI: 2.51, 6.00) and the odds of giving birth at home was 0.27 for women with less than 5 deliveries compared with women with 5 or more deliveries (adjusted OR 0.27; 95% CI: 0.15, 0.49) after controlling for confounders. The prevalence of home birth is high in Birnin Kudu and according to our respondents the main reasons for this practice are onset of labour late at night with lack of transportation and a limited choice of birthing positions. Provision of training and retraining of skilled birth attendants to assist women birthing in squatting positions would encourage women to deliver in the hospitals. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Effectiveness of Home Visits in Pregnancy as a Public Health Measure to Improve Birth Outcomes.

    Directory of Open Access Journals (Sweden)

    Kayoko Ichikawa

    Full Text Available Birth outcomes, such as preterm birth, low birth weight (LBW, and small for gestational age (SGA, are crucial indicators of child development and health.To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes.In this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14-19 years old, women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964, which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311 and included in the analysis. Data were analyzed between January and June 2014.In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98 and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92 compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5.Home visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.

  15. Young adults with very low birth weight: leaving the parental home and sexual relationships--Helsinki Study of Very Low Birth Weight Adults.

    Science.gov (United States)

    Kajantie, Eero; Hovi, Petteri; Räikkönen, Katri; Pesonen, Anu-Katriina; Heinonen, Kati; Järvenpää, Anna-Liisa; Eriksson, Johan G; Strang-Karlsson, Sonja; Andersson, Sture

    2008-07-01

    Although most children and adults who are born very preterm live healthy lives, they have, on average, lower cognitive scores, more internalizing behaviors, and deficits in social skills. This could well affect their transition to adulthood. We studied the tempo of first leaving the parental home and starting cohabitation with an intimate partner and sexual experience of young adults with very low birth weight (Adults, 162 very low birth weight individuals and 188 individuals who were born at term (mean age: 22.3 years [range: 18.5-27.1]) and did not have any major disability filled out a questionnaire. For analysis of their ages at events which had not occurred in all subjects, we used survival analysis (Cox regression), adjusted for gender, current height, parents' ages at the birth, maternal smoking during pregnancy, parental educational attainment, number of siblings, and parental divorce/death. During their late teens and early adulthood, these very low birth weight adults were less likely to leave the parental home and to start cohabiting with an intimate partner. In gender-stratified analyses, these hazard ratios were similar between genders, but the latter was statistically significant for women only. These very low birth weight adults were also less likely to experience sexual intercourse. This relationship was statistically significant for women but not for men; however, very low birth weight women and men both reported a smaller lifetime number of sex partners than did control subjects. Healthy young adults with very low birth weight show a delay in leaving the parental home and starting sexual activity and partnerships.

  16. Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.

    Science.gov (United States)

    Black, Maureen M; Bentley, Margaret E; Papas, Mia A; Oberlander, Sarah; Teti, Laureen O; McNary, Scot; Le, Katherine; O'Connell, Melissa

    2006-10-01

    were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended > or = 8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6-8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.

  17. Legal briefing: home birth and midwifery.

    Science.gov (United States)

    Pope, Thaddeus Mason; Fisch, Deborah

    2013-01-01

    This issue's "Legal Briefing" column covers recent legal developments involving home birth and midwifery in the United States. Specifically, we focus on new legislative, regulatory, and judicial acts that impact women's' access to direct entry (non-nurse) midwives. We categorize these legal developments into the following 12 categories. 1. Background and History 2. Certified Nurse-Midwives 3. Direct Entry Midwives 4. Prohibition of Direct Entry Midwives 5. Enforcement of Prohibition 6. Challenges to Prohibition 7. Forbearance without License 8. Voluntary Licensure 9. Unclear and Uncertain Status 10. Growth of DEM Licensure 11. Licensure Restrictions 12. Medicaid Coverage

  18. Communicating a New Consciousness: Countercultural Print and the Home Birth Movement in the 1970s.

    Science.gov (United States)

    Kline, Wendy

    2015-01-01

    This essay analyzes the production of three influential home birth texts of the 1970s written by self-proclaimed lay midwives that helped to fuel and sustain a movement in alternative birth practices. As part of a countercultural lifestyle print culture, early "how-to" books (Raven Lang's The Birth Book, Ina May Gaskin's Spiritual Midwifery) provided readers with vivid images and accounts in stark contrast to those of the sterile hospital delivery room. By the end of the decade, Rahima Baldwin's more mainstream guidebook, Special Delivery, indicated an interest in translating home birth to a wider audience who did not necessarily identify as "countercultural." Lay midwives who were authors of radical print texts in the 1970s played an important role in reshaping expectations about the birth experience, suggesting a need to rethink how we define the counterculture and its legacies.

  19. Child Home Care Allowance and the Transition to Second- and Third-Order Births in Finland.

    Science.gov (United States)

    Erlandsson, Anni

    2017-01-01

    Using register data from the Finnish Census Panel, this paper studies the relationship between the use of the child home care allowance and second and third births among women aged 20-44 in Finland during the period 1992-2007. Discrete-time event-history analysis is applied to examine (i) whether women taking up the child home care allowance while their previous child was under the age of 3 have a higher risk to proceed to subsequent childbearing, (ii) whether these women proceed to a further birth more quickly, and (iii) whether the risk to proceed to a subsequent birth is related to educational level. The results show that women using the allowance have a higher risk of having a second and a third birth than women not using it. The risk of having a second birth is higher than that of having a third birth. Also, women using the allowance get their subsequent child sooner than women not using the allowance. No large educational differences in the effect of allowance use are found for second or third births.

  20. Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia

    Science.gov (United States)

    2014-01-01

    Background A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Methods Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. Results There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. Conclusions The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not

  1. Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia.

    Science.gov (United States)

    Smith, Jeffrey Michael; Baawo, Saye Dahn; Subah, Marion; Sirtor-Gbassie, Varwo; Howe, Cuallau Jabbeh; Ishola, Gbenga; Tehoungue, Bentoe Z; Dwivedi, Vikas

    2014-06-04

    A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance

  2. Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

    Directory of Open Access Journals (Sweden)

    Nijhuis Jan G

    2009-11-01

    Full Text Available Abstract Background In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. Methods This study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis. Results In the group of home births, the total societal costs associated with giving birth at home were €3,695 (per birth, compared with €3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (€138.38 vs. €87.94, -50 (2.5-97.5 percentile range (PR-76;-25, p Conclusion The total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.

  3. Maternity waiting homes and institutional birth in Nicaragua: policy options and strategic implications.

    Science.gov (United States)

    García Prado, Ariadna; Cortez, Rafael

    2012-01-01

    With the aim of promoting institutional births and reducing the high maternal and child mortality rates in rural and poor zones, the government of Nicaragua is supporting the creation of maternity waiting homes. This study analyzes that strategy and examines the factors associated with the use of maternity waiting homes and institutional birth. To that end, we apply a quantitative approach, by means of an econometric analysis of the data extracted from surveys conducted in 2006 on a sample of women and parteras or traditional birth attendants, as well as a qualitative approach based on interviews with key informants. Results indicate that although the operation of the maternity waiting homes is usually satisfactory, there is still room for improvement along the following lines: (i) disseminating information about the homes to both women and men, as the latter frequently decide the course of women's healthcare, and to parteras, who can play an important role in referring women; (ii) strengthening the postpartum care; (iii) ensuring financial sustainability by obtaining regular financial support from the government to complement contributions from the community; and (iv) strengthening the local management and involvement of the regional government. These measures might be useful for health policy makers in Nicaragua and in other developing countries that are considering this strategy. Copyright © 2011 John Wiley & Sons, Ltd.

  4. Does a referral from home to hospital affect satisfaction with childbirth? A cross-national comparison

    Directory of Open Access Journals (Sweden)

    Gouwy Anneleen

    2007-07-01

    Full Text Available Abstract Background The Belgian and Dutch societies present many similarities but differ with regard to the organisation of maternity care. The Dutch way of giving birth is well known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted. Dutch and Belgian maternity care systems are compared with regard to the influence of being referred to specialist care during pregnancy or intrapartum while planning for a home birth. We expect that a referral will result in lower satisfaction with childbirth, especially in Belgium. Methods Two questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first two weeks after childbirth, either at home or in a hospital. Of these, 563 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004–2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept. Results Belgian women are more satisfied than Dutch women and home births are more satisfying than hospital births. Women who are referred to the hospital while planning for a home birth are less satisfied than women who planned to give birth in hospital and did. A referral has a greater negative impact on satisfaction for Dutch women. Conclusion There is no reason to believe Dutch women receive hospital care of lesser quality than Belgian women in case of a referral. Belgian and Dutch attach different meaning to being referred, resulting in a different evaluation of childbirth. In the Dutch maternity care system home births lead to higher satisfaction, but once a referral to the hospital is necessary satisfaction drops and ends up lower than satisfaction with hospital births that were planned in advance

  5. Uterotonic use at home births in low-income countries: a literature review.

    Science.gov (United States)

    Flandermeyer, Dawn; Stanton, Cynthia; Armbruster, Deborah

    2010-03-01

    This literature review compiles data on rates of use, indications, types of provider, mode of administration, and dose of uterotonics used for home births in low-income countries, and identifies gaps meriting further research. Published and unpublished English language articles from 1995 through 2008 pertaining to home use of uterotonics were identified via electronic searches of medical and social science databases. In addition, bibliographies of articles were examined for eligible studies. Data were abstracted and analyzed by the objectives outlined for this review. Twenty-three articles met the inclusion/exclusion criteria. Use rates of uterotonics at home births ranged widely from 1% to 69%, with the large majority of observations from South Asia. Descriptive studies suggest that home use of uterotonics before delivery of the baby are predominantly administered by nonprofessionals to accelerate labor, and are not perceived as unsafe. To achieve maximum benefit and minimal harm, programs that increase access to uterotonics for postpartum hemorrhage prevention must take into account existing practices among pregnant women. Further research regarding access to uterotonics and intervention studies for provider behavior change regarding uterotonic use is warranted.

  6. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    NARCIS (Netherlands)

    Brocklehurst, P.; Kwee, A.; Birthplace in England Collaborative Group

    2011-01-01

    Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home,

  7. Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan.

    Science.gov (United States)

    Hameed, Waqas; Avan, Bilal Iqbal

    2018-01-01

    Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1. There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1

  8. 'I didn't think you were allowed that, they didn't mention that.' A qualitative study exploring women's perceptions of home birth.

    Science.gov (United States)

    Naylor Smith, Jo; Taylor, Beck; Shaw, Karen; Hewison, Alistair; Kenyon, Sara

    2018-04-18

    Evidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and is associated with reduced intervention rates and increased rates of normal birth. However the home birth rate in the UK is low, and few women choose this option. The aims of this study were to identify what influences multiparous women's choice of birth place, and to explore their views of home birth. Five focus groups were conducted with multiparous women (n = 28) attending mother and baby groups in a city in the UK with a diverse multi-ethnic population. Data were analysed thematically using the Framework Method, combining deductive and inductive approaches to the data. Several themes were developed from the data, these were: the expectation that birth would take place in an Obstetric Unit; perceptions of birth as a 'natural' event; lack of knowledge of what home birth looked like; and a lack of confidence in the reliability of the maternity service. Two themes emerged regarding the influences on women's choices: clear information provision, particularly for those from ethnic minority groups, and the role of health care professionals. A final theme concerned women's responses to the offer of choice. There are gaps in women's knowledge about the reality and practicalities of giving birth at home that have not been previously identified. Other findings are consistent with existing evidence, suggesting that many women still do not receive consistent, comprehensive information about home birth. The findings from this research can be used to develop approaches to meet women's information and support needs, and facilitate genuine choice of place of birth.

  9. Birth plan compliance and its relation to maternal and neonatal outcomes

    Directory of Open Access Journals (Sweden)

    Pedro Hidalgo-Lopezosa

    2017-12-01

    Full Text Available ABSTRACT Objective: to know the degree of fulfillment of the requests that women reflect in their birth plans and to determine their influence on the main obstetric and neonatal outcomes. Method: retrospective, descriptive and analytical study with 178 women with birth plans in third-level hospital. Inclusion criteria: low risk gestation, cephalic presentation, single childbirth, delivered at term. Scheduled and urgent cesareans without labor were excluded. A descriptive and inferential analysis of the variables was performed. Results: the birth plan was mostly fulfilled in only 37% of the women. The group of women whose compliance was low (less than or equal to 50% had a cesarean section rate of 18.8% and their children had worse outcomes in the Apgar test and umbilical cord pH; while in women with high compliance (75% or more, the percentage of cesareans fell to 6.1% and their children had better outcomes. Conclusion: birth plans have a low degree of compliance. The higher the compliance, the better is the maternal and neonatal outcomes. The birth plan can be an effective tool to achieve better outcomes for the mother and her child. Measures are needed to improve its compliance.

  10. Adaptation and Validation of the HOME-SF as a Caregiver-Report Home Environment Measure for Use in the Taiwan Birth Cohort Study (TBCS)

    Science.gov (United States)

    Wu, Jennifer Chun-Li; Chiang, Tung-liang; Bradley, Robert H.

    2011-01-01

    This study aimed to develop a brief caregiver-report instrument for measuring the home environment of children aged three and under, as part of the Taiwan Birth Cohort Study (TBCS). Instrument development was conducted by translating and adapting the Home Observation for the Measurement of Environment Inventory-Short Form (HOME-SF) which comprises…

  11. The determinants of essential newborn care for home births in Bangladesh.

    Science.gov (United States)

    Akter, T; Dawson, A; Sibbritt, D

    2016-12-01

    To examine the association of sociodemographic, antenatal and delivery care factors with the essential newborn care (ENC) practices of neonates born at home in Bangladesh. This study analyzed data of a cross-sectional survey-the Bangladesh Demographic and Health Survey, 2011. This analysis considered 3190 most recent live-born infants who were delivered at home within three years of the survey. Logistic regression models were used to identify the factors affecting the implementation of six ENC practices, namely using disinfected instruments to cut the umbilical cord, avoidance of application of any substances to the umbilical cord stump, immediate drying and wrapping of newborns, delayed bathing of newborns, and immediate initiation of breastfeeding. Factors affecting ENC practices in Bangladesh are low parental education, low utilization of antenatal care services, the absence of skilled birth attendants, smaller size at birth, higher birth order and mother's age at birth. Regional factors also seem to considerably affect ENC practices. There is ample scope to improve the coverage of ENC practices in Bangladesh. Health promotion programmes that target parents with low education and older mothers may help to build awareness of ENC practices. This investigation provides insight into the key determinants of ENC practices, which require consideration when scaling up ENC practices in low-income and lower middle-income countries. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  12. Rhesus negative pregnant women in a traditional birth home in ...

    African Journals Online (AJOL)

    In a survey of 200 pregnant women (mean age 24 years) attending a traditional birth home (TBH) in Abeokuta, Nigeria, 19 (9.5%) were found to be rhesus negative, 8 (42.1%) of which were primigravidae while 11 (57.9%) were multigravidae. 87.5% of the Rhesus negative primigravidae delivered at the TBH without being ...

  13. The birth beliefs scale - a new measure to assess basic beliefs about birth.

    Science.gov (United States)

    Preis, Heidi; Benyamini, Yael

    2017-03-01

    Basic beliefs about birth as a natural and safe or a medical and risky process are central in the decisions on where and how to birth. Despite their importance, they have not been studied separately from other childbirth-related constructs. Our aim was to develop a measure to assess these beliefs. Pregnant Israeli women (N = 850, gestational week ≥14) were recruited in women's health centers, in online natural birth forums, and through home midwives. Participants filled in questionnaires including sociodemographic and obstetric background, the Birth Beliefs Scale (BBS), dispositional desire for control (DC) and planned mode of delivery. Factor analyses revealed that the BBS is composed of two factors: beliefs about birth as a natural process and beliefs about birth as a medical process. Both subscales showed good internal and test-retest reliability. They had good construct validity, predicted birth choices, and were weakly correlated with DC. Women's medical obstetric history was associated with the BBS, further supporting the validity of the scale. Beliefs about birth may be the building blocks that make up perceptions of birth and drive women's preferences. The new scale provides an easy way to distinctly assess them so they can be used to further understand planned birth behaviors. Additional studies are needed to comprehend how these beliefs form in different cultural contexts and how they evolve over time.

  14. Patient Communication, Satisfaction, and Trust Before and After Use of a Standardized Birth Plan.

    Science.gov (United States)

    Anderson, Clare-Marie; Monardo, Rosie; Soon, Reni; Lum, Jennifer; Tschann, Mary; Kaneshiro, Bliss

    2017-11-01

    The birth plan was developed as a way for pregnant women to communicate their desires and expectations for labor and delivery. Standardized birth plans have been used by some birth facilities as a communication tool. In this quality improvement project, we sought to describe communication, trust, and satisfaction scores after delivery in a group of patients who used a standardized birth plan. All pregnant women at 24 or more weeks of gestation were asked to complete a short, standardized birth plan. Communication, trust, and satisfaction were assessed before and after delivery. Descriptive analyses showed that communication, trust, and satisfaction scores were high following delivery. Scores for all three factors increased significantly following delivery though increases were modest. Most patients (84%) indicated they would use a birth plan with a subsequent delivery.

  15. Oxytocin to augment labour during home births: an exploratory study in the urban slums of Dhaka, Bangladesh.

    Science.gov (United States)

    Moran, A C; Wahed, T; Afsana, K

    2010-12-01

    In Bangladesh, the majority of women give birth at home. There is anecdotal evidence that unqualified allopathic practitioners (UAPs) administer oxytocin at home births to augment labour pain. The objective is to explore the use of oxytocin to augment labour pain during home births in an urban slum in Dhaka, Bangladesh. Cross-sectional survey. KamrangirChar slum, Dhaka, Bangladesh. Married women with a home birth or who experienced labour at home in the 6 months prior to the survey (n = 463) were interviewed. Twenty-seven UAPs were interviewed to validate women's responses. Bivariate and multivariate logistic regressions were used to identify significant predictors of oxytocin use. Reported use of oxytocin to augment labour pain. Forty-six percent of women reported using medicine or other treatments to augment labour pain, 131 of whom reported using oxytocin (28% of total). Traditional birth attendants were the predominant decision-makers of when to use oxytocin. The medication was provided by a UAP who administered the drug via saline infusion or intramuscular injection. Higher education, lower parity, reported long labour (more than 12 hours), and knowledge of and positive attitudes towards oxytocin were significantly associated with oxytocin use after controlling for other factors. In the validation exercise, there was agreement about the use of oxytocin to augment labour in 22 of 27 cases (82%). About one-third of women used oxytocin to augment labour pain. This practice has implications for health education as well as future research to assess the impact on adverse maternal and neonatal outcomes. © 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

  16. IMPLEMENTATION BIRTH PLANNING AND COMPLICATIONS PREVENTIONS PROGRAM (P4K ON COASTAL COMMUNITIES IN MAMUJU

    Directory of Open Access Journals (Sweden)

    Ashriady Ashriady

    2017-01-01

    Full Text Available The results of the 97 countries, there is a significant correlation between aid delivery with maternal mortality (Depkes, 2011. Proportion of birth in Indonesia showed 76.1% in Healthcare Facilities and 23.7% in home and another (Kemenkes RI, 2014. In the coastal community primary choices deliveries take place at home, assisted by shamans because mothers feel safe from evil spirits, and convenient for the family attended (Yunarti, 2013. Scope of delivery assistance by health workers in 2006 - 2011 in West Sulawesi has not reached the target of minimum service standards in 2015 by 90%, obstetric complications handled in 2011 in Mamuju 35.1%. The aim of research to analyze the implementation of Birth Planning and Complications Preventions Program (P4K based on the knowledge and attitude of Mother on Coastal Communities in Mamuju. This type of research is survey with cross sectional study design. In the study period in August-October 2016. The population is all Mother toddler who visited IHC 330, 149 of the samples obtained by using the formula, taken by accidental sampling method. The results showed 68 (81.9% of respondents have sufficient knowledge of the implementation of the less well P4K, 113 (79.6% positive attitude to the implementation mother P4K less good, there is no statistical relationship between knowledge and attitude of mothers with implementation P4K. Midwives need intensive assistance in filling and installation sticker P4K at home mom.

  17. Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

    OpenAIRE

    Hendrix, Marijke JC; Evers, Silvia MAA; Basten, Marloes CM; Nijhuis, Jan G; Severens, Johan L

    2009-01-01

    Abstract Background In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. Methods This study is a cost analysis based on the finding...

  18. Home or hospital? Midwife or physician? Preferences for maternity care provider and place of birth among Western Australian students.

    Science.gov (United States)

    Stoll, Kathrin H; Hauck, Yvonne L; Hall, Wendy A

    2016-02-01

    Australian caesarean birth rates have exceeded 30% in most states and are approaching 45%, on average, in private hospitals. Australian midwifery practice occurs almost exclusively in hospitals; less than 3% of women deliver at home or in birthing centres. It is unclear whether the trend towards hospital-based, high interventionist birth reflects preferences of the next generation of maternity care consumers. We conducted a descriptive cross-sectional online survey of 760 Western Australian (WA) university students in 2014, to examine their preferences for place of birth, type of maternity care, mode of birth and attitudes towards birth. More students who preferred midwives (35.8%) had vaginal birth intentions, contested statements that birth is unpredictable and risky, and valued patient-provider relationships. More students who preferred obstetricians (21.8%) expressed concerns about childbirth safety, feared birth, held favourable views towards obstetric technology, and expressed concerns about the impact of pregnancy and birth on the female body. One in 8 students preferred out-of-hospital birth settings, supporting consumer demand for midwife-attended births at home and in birthing centres. Stories and experiences of friends and family shaped students' care provider preferences, rather than the media or information learned at school. Students who express preferences for midwives have significantly different views about birth compared to students who prefer obstetricians. Increasing access to midwifery care in all settings (hospital, birthing centre and home) is a cost effective strategy to decrease obstetric interventions for low risk women and a desirable option for the next generation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  19. Birth planning and sterilization in China.

    Science.gov (United States)

    Short, S E; Linmao, M; Wentao, Y

    2000-11-01

    Sterilization is the most prevalent method of contraception in China. Approximately half of all women of reproductive age report that they or their husbands are sterilized. Using data from the China Health and Nutrition Survey we describe patterns of sterilization in eight Chinese provinces. With a discrete-time event history model we investigate the link between characteristics of local birth planning policy and the risk of sterilization. After controlling for parity, the risk of sterilization is highest in communities where birth planning policy is least strong as measured by exceptions to the one-child policy. These results suggest that couples with more flexibility in family building may have less control over contraceptive method use. Other factors affecting the risk of sterilization are a woman's age, parity, and whether or not she has a son. Our results emphasize the importance of taking into account multiple dimensions of reproductive behaviour when assessing one-child policy changes.

  20. Plans, preferences or going with the flow: an online exploration of women's views and experiences of birth plans

    OpenAIRE

    Divall, Bernie; Spiby, Helen; Nolan, Mary; Slade, Pauline

    2017-01-01

    Objective\\ud To explore women’s views of birth plans, and experiences of their completion and use.\\ud Design\\ud A qualitative, exploratory study, using Internet-mediated research methods.\\ud Setting\\ud The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted.\\ud Participants\\ud Members of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan.\\ud Findings\\ud ...

  1. The absolute power of relative risk in debates on repeat cesareans and home birth in the United States.

    Science.gov (United States)

    Declercq, Eugene

    2013-01-01

    Changes in policies and practices related to repeat cesareans and home birth in the U.S. have been influenced by different interpretations of the risk of poor outcomes. This article examines two cases-vaginal birth after cesarean (VBAC) and home birth to illustrate how an emphasis on relative over absolute risk has been used to characterize outcomes associated with these practices. The case studies will rely on reviews of the research literature and examination of data on birth trends and outcomes. Childbirth involves some unique challenges in assessing health risks, specifically the issues of: (1) timing of risks (lowering health risk in a current birth can increase it in subsequent births); (2) the potential weighing of risks to the mother's versus the infant's health; (3) the fact that birth is a condition of health and many of the feared outcomes (for example, symptomatic uterine rupture) involve very low absolute risk of occurrence; and (4) a malpractice environment that seizes upon those rare poor outcomes in highly publicized lawsuits that receive widespread attention in the clinical community. In the cases of VBAC and home birth, the result has been considerable emphasis on relative risks, typically an adjusted odds ratio, with little consideration of absolute risks. Assessments of the safety of interventions in childbirth should involve careful consideration and communication of the multiple dimensions of risk, particularly a balancing of relative and absolute risks of poor health outcomes.

  2. Effect of home and hospital delivery on long-term cognitive function.

    Science.gov (United States)

    Sørensen, H T; Steffensen, F H; Rothman, K J; Gillman, M W; Fischer, P; Sabroe, S; Olsen, J

    2000-11-01

    We examined the relation between place of birth and cognitive function in young adult life in a historical cohort study based upon birth data from the computerized Danish Medical Birth Registry and cognitive function as measured at time of drafting for military service in two Danish counties. The cohort included 4,296 Danish conscripts born between 1973 and 1976, 123 born at home and 4,173 born in hospital or at a birth clinic. Cognitive function was measured by the Boerge Prien test in men, 18 to 20 years of age. The highest possible score is 78. The mean Boerge Prien test score was 43.1 for conscripts born in specialized hospital departments, 2.4 higher for conscripts born in a birth clinic (95% confidence interval = 0.9-4.0), and 2.1 lower for conscripts born at home (95% confidence limits = -3.8 to -0.4) after adjusting for birth weight, length at birth, birth order, gestational age, maternal age, and marital and occupational status. Our findings raise the possibility that home birth can lead to lower cognitive function in adulthood; however, from our data we could not distinguish between planned and unplanned births at home.

  3. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study.

    Science.gov (United States)

    Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C

    2015-09-11

    Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women's preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. We conducted ten focus group discussions (n = 100) with women of reproductive age (15-45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. Our findings show that women's lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. Our findings suggest a need to empower women with decision-making skills

  4. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date.

    Science.gov (United States)

    Smith, Jeffrey Michael; Gubin, Rehana; Holston, Martine M; Fullerton, Judith; Prata, Ndola

    2013-02-20

    Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events. Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these

  5. Where There Are (Few) Skilled Birth Attendants

    Science.gov (United States)

    Prata, Ndola; Rowen, Tami; Bell, Suzanne; Walsh, Julia; Potts, Malcolm

    2011-01-01

    Recent efforts to reduce maternal mortality in developing countries have focused primarily on two long-term aims: training and deploying skilled birth attendants and upgrading emergency obstetric care facilities. Given the future population-level benefits, strengthening of health systems makes excellent strategic sense but it does not address the immediate safe-delivery needs of the estimated 45 million women who are likely to deliver at home, without a skilled birth attendant. There are currently 28 countries from four major regions in which fewer than half of all births are attended by skilled birth attendants. Sixty-nine percent of maternal deaths in these four regions can be attributed to these 28 countries, despite the fact that these countries only constitute 34% of the total population in these regions. Trends documenting the change in the proportion of births accompanied by a skilled attendant in these 28 countries over the last 15-20 years offer no indication that adequate change is imminent. To rapidly reduce maternal mortality in regions where births in the home without skilled birth attendants are common, governments and community-based organizations could implement a cost-effective, complementary strategy involving health workers who are likely to be present when births in the home take place. Training community-based birth attendants in primary and secondary prevention technologies (e.g. misoprostol, family planning, measurement of blood loss, and postpartum care) will increase the chance that women in the lowest economic quintiles will also benefit from global safe motherhood efforts. PMID:21608417

  6. Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

    2010-02-01

    We sought to evaluate perinatal morbidity by delivery location (hospital, freestanding birth center, and home). Selected 2006 US birth certificate data were accessed online from the Centers for Disease Control and Prevention. Low-risk maternal and newborn outcomes were tabulated and compared by birth facility. A total of 745,690 deliveries were included, of which 733,143 (97.0%) occurred in hospital, 4661 (0.6%) at birth centers, and 7427 (0.9%) at home. Compared with hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors. Home births experienced more frequent 5-minute Apgar scores home and birthing center deliveries were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and birthweight Home births are associated with a number of less frequent adverse perinatal outcomes at the expense of more frequent abnormal labors and low 5-minute Apgar scores. Copyright 2010 Mosby, Inc. All rights reserved.

  7. Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia.

    Science.gov (United States)

    Pagel, Christina; Prost, Audrey; Hossen, Munir; Azad, Kishwar; Kuddus, Abdul; Roy, Swati Sarbani; Nair, Nirmala; Tripathy, Prasanta; Saville, Naomi; Sen, Aman; Sikorski, Catherine; Manandhar, Dharma S; Costello, Anthony; Crowe, Sonya

    2014-03-07

    Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India. We used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these data to identify essential newborn care practices as defined by the World Health Organization. Each birth was allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional delivery. For each study, we calculated the observed proportion of births that received each care practice by delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification. After exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765 births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional deliveries did not provide universal coverage of the recommended practices, with relatively low coverage (20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home non-SBA deliveries used a clean delivery kit, the use of

  8. Increasing Access to Prevention of Postpartum Hemorrhage Interventions for Births in Health Facilities and at Home in Four Districts of Rwanda.

    Science.gov (United States)

    Dao, Blami; Ngabo, Fidele; Zoungrana, Jeremie; Rawlins, Barbara; Mukarugwiro, Beata; Musoni, Pascal; Favero, Rachel; MacDowell, Juliet; Eugene, Kanyamanza

    2015-12-01

    To assess coverage, acceptability, and feasibility of a program to prevent postpartum hemorrhage (PPH) at community and facility levels, a study was conducted in 60 health facilities and their catchment areas in four districts in Rwanda. A total of 220 skilled birth attendants at these facilities were trained to provide active management of the third stage of labor and 1994 community health workers (ASMs) were trained to distribute misoprostol at home births. A total of 4,074 pregnant women were enrolled in the program (20.5% of estimated deliveries). Overall uterotonic coverage was 82.5%: 85% of women who delivered at a facility received a uterotonic to prevent PPH; 76% of women reached at home at the time of birth by an ASM ingested misoprostol--a 44.3% coverage rate. Administration of misoprostol at the time of birth for home births achieved moderate uterotonic coverage. Advancing the distribution of misoprostol through antenatal care services could further increase coverage.

  9. Saving lives at birth

    DEFF Research Database (Denmark)

    Daysal, N. Meltem; Trandafir, Mircea; van Ewijk, Reyn

    2015-01-01

    Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity...... in location of birth, we exploit the exogenous variation in distance from a mother’s residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important...

  10. [The planned home care transfer by a local medical support hospital and the introduction to home intravenous hyper alimentation--the making of a home care patient's instruction plan document].

    Science.gov (United States)

    Shinobu, Akiko; Ohtsu, Yoko

    2004-12-01

    It is important to offer continuous medical service without interrupting everyone's various job functions at the Tama Numbu-Chiiki Hospitals in order to secure the quality and safety of home medical care to patients and their families. From 1998 up to the present, home intravenous hyper alimentation (home IVH) has been introduced by individually exchanging information that was based on items such as clinical case, doctor and caregiver in charge of the day, and introductory information. Five years have passed since we started an introduction of home IVH, and it appears that the medical cooperation of home IVH between the Minami-tama medical region and its neighboring area has been established. Then, we arranged an examination of the past 2 years based on the 57 patients who elected to choose home IVH instruction. Consequently, we created "home IVH introduction plan document" in standardizing a flow from home IVH introduction to post-hospital intervention. Since November of 2003, the plan document has been utilized and carried out to 5 patients by the end of February in 2004. This home IVH introduction plan document was able to clarify the role of medical person in connection with the patient. Therefore, we could not only share the information, but also could transfer medical care smoothly from the hospital to the patient's home.

  11. [Birthing institutions and births in Norwegian counties in the early 1990s].

    Science.gov (United States)

    Bergsjø, P; Daltveit, A K

    1996-05-20

    Between 1972 and 1993 the number of hospitals and maternity homes providing obstetric help in Norway fell from 158 to 67. Most of the decline is explained by the closing down of maternity homes and obstetrical units in small hospitals, partly due to a reduction in number of births and partly to a deliberate drive towards giving birth in larger units. 16 of the 19 counties of Norway contained four or fewer obstetric institutions in 1993. Nevertheless, most of the 60,000 births took place in institutions with between 500 and 2,999 births annually. Births at home accounted for 0.3%, and births during transport for 0.2% of the total in 1990 and 1993.

  12. Prevention of postpartum hemorrhage at home birth in Afghanistan.

    Science.gov (United States)

    Sanghvi, Harshadkumar; Ansari, Nasratullah; Prata, Ndola J V; Gibson, Hannah; Ehsan, Aftab T; Smith, Jeffrey M

    2010-03-01

    To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. A nonrandomized experimental control design in rural Afghanistan. A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas. In Afghanistan, community-based education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should be considered for other countries where access to skilled attendance is limited.

  13. Birthing Classes

    Science.gov (United States)

    ... management options. Breastfeeding basics. Caring for baby at home. Birthing classes are not just for new parents, though. ... midwife. Postpartum care. Caring for your baby at home, including baby first aid. Lamaze One of the most popular birthing techniques in the U.S., Lamaze has been around ...

  14. The relationship between planned and reported home infant sleep locations among mothers of late preterm and term infants.

    Science.gov (United States)

    Tully, Kristin P; Holditch-Davis, Diane; Brandon, Debra

    2015-07-01

    To compare maternal report of planned and practiced home sleep locations of infants born late preterm (34 0/7 to 36 6/7 gestational weeks) with those infants born term (≥37 0/7 gestational weeks) over the first postpartum month. Open-ended semi-structured maternal interviews were conducted in a US hospital following birth and by phone at 1 month postpartum during 2010-2012. Participants were 56 mother-infant dyads: 26 late preterm and 30 term. Most women planned to room share at home with their infants and reported doing so for some or all of the first postpartum month. More women reported bed sharing during the first postpartum month than had planned to do so in both the late preterm and term groups. The primary reason for unplanned bed sharing was to soothe nighttime infant fussiness. Those participants who avoided bed sharing at home commonly discussed their fear for infant safety. A few parents reported their infants were sleeping propped on pillows and co-sleeping on a recliner. Some women in both the late preterm and term groups reported lack of opportunity to obtain a bassinet prior to childbirth. The discrepancy between plans for infant sleep location at home and maternally reported practices were similar in late preterm and term groups. Close maternal proximity to their infants at night was derived from the need to assess infant well-being, caring for infants, and women's preferences. Bed sharing concerns related to infant safety and the establishment of an undesirable habit, and alternative arrangements included shared recliner sleep.

  15. Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial.

    Science.gov (United States)

    Lutenbacher, Melanie; Gabbe, Patricia Temple; Karp, Sharon M; Dietrich, Mary S; Narrigan, Deborah; Carpenter, Lavenia; Walsh, William

    2014-07-01

    Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20-home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62% had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.

  16. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth-to-mouth, tube-mask or bag-mask.

    Science.gov (United States)

    Bang, Abhay T; Bang, Rani A; Baitule, Sanjay B; Reddy, Hanimi M; Deshmukh, Mahesh D

    2005-03-01

    To evaluate the effect of home-based neonatal care on birth asphyxia and to compare the effectiveness of two types of workers and three methods of resuscitation in home delivery. In a field trial of home-based neonatal care in rural Gadchiroli, India, birth asphyxia in home deliveries was managed differently during different phases. Trained traditional birth attendants (TBA) used mouth-to-mouth resuscitation in the baseline years (1993 to 1995). Additional village health workers (VHWs) only observed in 1995 to 1996. In the intervention years (1996 to 2003), they used tube-mask (1996 to 1999) and bag-mask (1999 to 2003). The incidence, case fatality (CF) and asphyxia-specific mortality rate (ASMR) during different phases were compared. During the intervention years, 5033 home deliveries occurred. VHWs were present during 84% home deliveries. The incidence of mild birth asphyxia decreased by 60%, from 14% in the observation year (1995 to 1996) to 6% in the intervention years (pASMR by 65%, from 11 to 4% (pASMR by 12%, tube-mask further reduced the CF by 27% and the ASMR by 67%. The bag-mask showed an additional decrease in CF of 39% and in the fresh stillbirth rate of 33% in comparison to tube-mask (not significant). The cost of bag and mask was US dollars 13 per averted death. Oxytocic injection administered by unqualified doctors showed an odds ratio of three for the occurrence of severe asphyxia or fresh stillbirth. Home-based interventions delivered by a team of TBA and a semiskilled VHW reduced the asphyxia-related neonatal mortality by 65% compared to only TBA. The bag-mask appears to be superior to tube-mask or mouth-to-mouth resuscitation, with an estimated equipment cost of US dollars 13 per death averted.

  17. Is attendant at delivery associated with the use of interventions to prevent postpartum hemorrhage at home births? The case of Bangladesh.

    Science.gov (United States)

    Prata, Ndola; Bell, Suzanne; Holston, Martine; Quaiyum, Mohammad A

    2014-01-16

    Hemorrhage is the leading cause of maternal mortality in Bangladesh, the majority of which is due to postpartum hemorrhage (PPH), blood loss of 500 mL or more. Many deaths due to PPH occur at home where approximately 77% of births take place. This paper aims to determine whether the attendant at home delivery (i.e. traditional birth attendant (TBA) trained on PPH interventions, TBA not trained on interventions, or lay attendant) is associated with the use of interventions to prevent PPH at home births. Data come from operations research to determine the safety, feasibility, and acceptability of scaling-up community-based provision of misoprostol and an absorbent delivery mat in rural Bangladesh. Analyses were done using data from antenatal care (ANC) cards of women who delivered at home without a skilled attendant (N =66,489). Multivariate logistic regression was used to assess the likelihood of using the interventions. Overall, 67% of women who delivered at home without a skilled provider used misoprostol and the delivery mat (the interventions). Women who delivered at home and had a trained TBA present had 2.72 (95% confidence interval, 2.15-3.43) times the odds of using the interventions compared to those who had a lay person present. With each additional ANC visit (maximum of 4) a woman attended, the odds of using the interventions increased 2.76 times (95% confidence interval, 2.71-2.81). Other sociodemographic variables positively associated with use of the interventions were age, secondary or higher education, and having had a previous birth. Findings indicate that trained TBAs can have a significant impact on utilization of interventions to prevent PPH in home births. ANC visits can be an important point of contact for knowledge transfer and message reinforcement about PPH prevention.

  18. Home Birth Midwifery in the United States : Evolutionary Origins and Modern Challenges.

    Science.gov (United States)

    Dunham, Bria

    2016-12-01

    Human childbirth is distinct in requiring-or at least strongly profiting from-the assistance of a knowledgeable attendant to support the mother during birth. With economic modernization, the role of that attendant is transformed, and increased access to obstetric interventions may bring biomedicine into conflict with anatomical, physiological, and behavioral adaptations for childbirth. This article provides an overview of the role of midwifery in human evolution and ways in which this evolutionary heritage is reflected in home birth in the contemporary United States. Opportunities remain for evolutionary scholars to apply their knowledge and skills to strengthen culturally consonant, evolutionarily grounded maternity care within a complex, multilevel, pluralistic medical system.

  19. Women's experiences of planning a vaginal breech birth in Australia.

    Science.gov (United States)

    Homer, Caroline Se; Watts, Nicole P; Petrovska, Karolina; Sjostedt, Chauncey M; Bisits, Andrew

    2015-04-11

    In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. A qualitative study using descriptive exploratory design was undertaken. Twenty-two (n = 22) women who planned a VBB, regardless of eventual mode of birth were recruited. The women had given birth at one of two maternity hospitals in Australia that supported VBB. In-depth, semi-structured interviews using an interview guide were conducted. Interviews were analysed thematically. Twenty two women were interviewed; three quarters were primiparous (n = 16; 73%). Nine (41%) were already attending a hospital that supported VBB with the remaining women moving hospitals. All women actively sought a vaginal breech birth because the baby remained breech after an external cephalic version - 12 had a vaginal birth (55%) and 10 (45%) a caesarean section after labour commenced. There were four main themes: Reacting to a loss of choice and control, Wanting information that was trustworthy, Fighting the system and seeking support for VBB and The importance of 'having a go' at VBB. Women seeking a VBB value clear, consistent and relevant information in deciding about mode of birth. Women desire autonomy to choose vaginal breech birth and to be supported in their choice with high quality care.

  20. Home or hospital birth: a prospective study of midwifery care in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.

    1997-01-01

    A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to

  1. Does planning of births affect childhood undernutrition? Evidence from demographic and health surveys of selected South Asian countries.

    Science.gov (United States)

    Rana, Md Juel; Goli, Srinivas

    2018-03-01

    The prevalence of child undernutrition in South Asia is high, as is also the unmet need for family planning. In previous literature, the biodemographic relationship of family planning, particularly birth order and birth spacing, and nutritional status of children have been assessed separately. The aim of this study was to work on the hypothesis that the planning of births comprising timing, spacing, and number of births improves child undernutrition, especially in the areas with high prevalence of stunting and underweight. We used recent Demographic and Health Survey data from four selected South Asian countries. Binary logistic regression models were applied to estimate the adjusted percentage of stunting and underweight by identified independent factors. Findings suggested that after controlling for other socioeconomic factors, children in the first birth order with >24 mo of interval between marriage and first birth have a lower risk for stunting (20%; p planning of births. The probability of child undernutrition is lower among children born with >24 mo of birth spacing than its counterpart in all birth orders, but the significance of birth spacing reduces with increasing birth orders. Appropriate planning of births using family planning methods in countries with high birth rates has the potential to reduce childhood undernutrition. Thus, the planning of births emerges as an important biodemographic approach to eradicate childhood undernutrition especially in developing regions like South Asia and thereby to achieve sustainable development goals by 2030. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Child Home Care Allowance: Transition to Second- and Third-Order Births in Finland

    OpenAIRE

    Pajunen, Anni

    2012-01-01

    In this study, I study the relationship between the use of the child home care allowance and second and third births among women aged 19-44 in Finland. I use register data from the Finnish Census Panel (FCP) on 254 465 women who had a second or third child during 1993 to 2007. I apply discrete-time event-history analysis to examine whether women using the child home care allowance while their previous child was under the age of three have a higher risk to proceed to subsequent childbearing – ...

  3. The New Rich and Their Unplanned Births: Stratified Reproduction under China's Birth-planning Policy.

    Science.gov (United States)

    Shi, Lihong

    2017-12-01

    This article explores the creation and ramifications of a stratified reproductive system under China's state control of reproduction. Within this system, an emerging group of "new rich" are able to circumvent birth regulations and have unplanned births because of their financial capabilities and social networks. While China's birth-planning policy is meant to be enforced equally for all couples, the unequal access to wealth and bureaucratic power as a result of China's widening social polarization has created disparate reproductive rights and experiences. This article identifies three ways in which reproductive privileges are created. It further explores how a stratified reproductive system under state population control reinforces social polarization. While many socially marginalized couples are unable to register their unplanned children for citizenship status and social benefits, the new rich are able to legitimate their births and transfer their privilege and status to their children, thus reproducing a new generation of elites. © 2016 by the American Anthropological Association.

  4. Born a bit too early: A study of early planned birth and child development at school age

    Directory of Open Access Journals (Sweden)

    Jason Bentley

    2017-04-01

    Early (<39 weeks gestation planned birth is associated with an increased risk of poor development in children starting school. Given the timing of planned birth is modifiable, delaying birth for an additional week or more may improve child development. Strategies and interventions to inform more judicious decision making, weighing all the risks and benefits for early planned birth are required to ensure optimal child health and development.

  5. Infants delivered in maternity homes run by traditional birth attendants in urban Nigeria: a community-based study.

    Science.gov (United States)

    Olusanya, Bolajoko O; Inem, Victor A; Abosede, Olayinka A

    2011-06-01

    We explored factors associated with traditional maternity/herbal homes (TMHs) run by traditional birth attendants (TBAs) compared with hospital or home delivery in Lagos, Nigeria, and found that infants delivered at TMHs were less likely to have severe hyperbilirubinemia compared with infants delivered in hospitals or residential homes. These infants were also less likely to be preterm compared with those delivered in hospitals or undernourished compared with infants delivered in residential homes. We concluded that infants delivered at TMHs who survive are unlikely to be at greater risks of some adverse perinatal outcomes than those delivered in hospitals or family homes.

  6. Birth control, population control, and family planning: an overview.

    Science.gov (United States)

    Critchlow, D T

    1995-01-01

    This overview of the US birth control movement reflects on the emergence of family planning policy due to the efforts of Margaret Sanger, feminists, and the civil rights movement, the eugenics motive to limit "deviant" populations, and the population control movement, which aims to solve social and economic problems through fertility control. Population control moved through three stages: from the cause of "voluntary motherhood" to advance suffrage and women's political and social status, to the concept of "birth control" promoted by socialist feminists to help empower women and the working class, to, from 1920 on, a liberal movement for civil rights and population control. Physicians such as Dr. Robert Latou Dickinson legitimized the movement in the formation of the Committee on Maternal Health in 1925, but the movement remained divided until 1939, when Sanger's group merged with the American Birth Control League, the predecessor of the present Planned Parenthood Federation of America. A key legal decision in 1939 in the United States v. One Package amended the Comstock Act and allowed for the distribution of birth control devices by mail to physicians. Sanger, after a brief retirement, formed the International Planned Parenthood Federation and supported research into the pill. Eugenicists through the Committee on Maternal Health supported Christopher Tietze and others developing the pill. Final constitutional access to contraception based on the right to privacy was granted in Griswold v. Connecticut. The ruling in Eisenstadt v. Baird in 1972 extended this right to unmarried persons. The right to privacy was further extended in the Roe v. Wade decision in 1973 on legal abortion. The argument for improving the quality of the population remained from the formation of the Population Reference Bureau in 1929 through the 1960s. Under the leadership of Rockefeller, population control was defined as justified on a scientific and humanitarian basis. US government support

  7. Why do women prefer home births in Ethiopia?

    Directory of Open Access Journals (Sweden)

    Shiferaw Solomon

    2013-01-01

    Full Text Available Abstract Background Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. Methods The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions. Results Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78% was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42% and not customary (36%, followed by high cost (22% and distance or lack of transportation (8%. The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want, and economic constraints during referral contribute to the low level of service utilization. Conclusions The study

  8. Why do women prefer home births in Ethiopia?

    Science.gov (United States)

    Shiferaw, Solomon; Spigt, Mark; Godefrooij, Merijn; Melkamu, Yilma; Tekie, Michael

    2013-01-16

    Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15-49 year old women combined with in-depth interviews and focus group discussions. Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women's low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization. The study indicated the crucial role of proper health care provider

  9. Out-of-hospital births in the United States 2009-2014.

    Science.gov (United States)

    Grunebaum, Amos; Chervenak, Frank A

    2016-10-01

    To evaluate recent trends of out-of-hospital births in the US from 2009 to 2014. We accessed data for all live births occurring in the US from the National Vital Statistics System, Natality Data Files for 2009-2014 through the interactive data tool, VitalStats. Out-of-hospital (OOH) births in the US increased from 2009 to 2014 by 80.2% from 32,596 to 58,743 (0.79%-1.47% of all live births). Home births (HB) increased by 77.3% and births in freestanding birthing centers (FBC) increased by 79.6%. In 2014, 63.8% of OOH births were HB, 30.7% were in FBC, and 5.5% were in other places, physicians offices, or clinics. The majority of women who had an OOH birth in 2014 were non-Hispanic White (82.3%). About in one in 47 non-Hispanic White women had an OOH in 2014, up from 1 in 87 in 2009. Women with a HB were older compared to hospital births (age ≥35: 21.5% vs. 15.4%), had a higher live birth order(≥5: 18.9% vs. 4.9%), 3.48% had infants home and in freestanding birthing centers has significantly increased in the US making it the country with the most out of hospital births among all developed countries. The root cause of the increase in planned OOH births should be identified and addressed by the medical community.

  10. Women's attitudes towards the medicalization of childbirth and their associations with planned and actual modes of birth.

    Science.gov (United States)

    Benyamini, Yael; Molcho, Maya Lila; Dan, Uzi; Gozlan, Miri; Preis, Heidi

    2017-10-01

    Rates of medical interventions in childbirth have greatly increased in the Western world. Women's attitudes affect their birth choices. To assess women's attitudes towards the medicalization of childbirth and their associations with women's background as well as their fear of birth and planned and unplanned modes of birth. This longitudinal observational study included 836 parous woman recruited at women's health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at birth. Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. Understanding women's views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  11. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States.

    Science.gov (United States)

    Bovbjerg, Marit L; Cheyney, Melissa; Brown, Jennifer; Cox, Kim J; Leeman, Lawrence

    2017-09-01

    There is little agreement on who is a good candidate for community (home or birth center) birth in the United States. Data on n=47 394 midwife-attended, planned community births come from the Midwives Alliance of North America Statistics Project. Logistic regression quantified the independent contribution of 10 risk factors to maternal and neonatal outcomes. Risk factors included: primiparity, advanced maternal age, obesity, gestational diabetes, preeclampsia, postterm pregnancy, twins, breech presentation, history of cesarean and vaginal birth, and history of cesarean without history of vaginal birth. Models controlled additionally for Medicaid, race/ethnicity, and education. The independent contributions of maternal age and obesity were quite modest, with adjusted odds ratios (AOR) less than 2.0 for all outcomes: hospital transfer, cesarean, perineal trauma, postpartum hemorrhage, low/very-low Apgar, maternal or neonatal hospitalization, NICU admission, and fetal/neonatal death. Breech was strongly associated with morbidity and fetal/neonatal mortality (AOR 8.2, 95% CI, 3.7-18.4). Women with a history of both cesarean and vaginal birth fared better than primiparas across all outcomes; however, women with a history of cesarean but no prior vaginal births had poor outcomes, most notably fetal/neonatal demise (AOR 10.4, 95% CI, 4.8-22.6). Cesarean births were most common in the breech (44.7%), preeclampsia (30.6%), history of cesarean without vaginal birth (22.1%), and primipara (11.0%) groups. The outcomes of labor after cesarean in women with previous vaginal deliveries indicates that guidelines uniformly prohibiting labor after cesarean should be reconsidered for this subgroup. Breech presentation has the highest rate of adverse outcomes supporting management of vaginal breech labor in a hospital setting. © 2017 Wiley Periodicals, Inc.

  12. Praxis and guidelines for planned homebirths in the Nordic countries - an overview

    DEFF Research Database (Denmark)

    Lindgren, Helena; Kjaergaard, Hanne; Olafsdottir, Olof Asta

    2014-01-01

    to a midwife attending the birth varies geographically. In the Stockholm County Council guidelines have been developed for publicly funding of planned home births; for the rest of Sweden no national guidelines have been formulated and the service is privately funded. KEY CONCLUSION: Inconsistencies in the home...... birth services of the Nordic countries imply different opportunities for midwifery care to women with regard to their preferred place of birth. Uniform sociodemography, health care systems and cultural context in the Nordic countries are factors in favour of further research to compare and aggregate...... woman has the right to be attended by a midwife during a homebirth and each county council must present a plan for the organization of birth services, including homebirth services. In Norway and Iceland the service is fully or partly funded by taxes and national guidelines are available but access...

  13. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    International Nuclear Information System (INIS)

    Phillipson, Frank

    2015-01-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work. (paper)

  14. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    Science.gov (United States)

    Phillipson, Frank

    2015-05-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.

  15. International Thermonuclear Experimental Reactor U.S. Home Team Quality Assurance Plan

    Energy Technology Data Exchange (ETDEWEB)

    Sowder, W. K.

    1998-10-01

    The International Thermonuclear Experimental Reactor (ITER) project is unique in that the work is divided among an international Joint Central Team and four Home Teams, with the overall responsibility for the quality of activities performed during the project residing with the ITER Director. The ultimate responsibility for the adequacy of work performed on tasks assigned to the U.S. Home Team resides with the U.S. Home Team Leader and the U.S. Department of Energy Office of Fusion Energy (DOE-OFE). This document constitutes the quality assurance plan for the ITER U.S. Home Team. This plan describes the controls exercised by U.S. Home Team management and the Performing Institutions to ensure the quality of tasks performed and the data developed for the Engineering Design Activities assigned to the U.S. Home Team and, in particular, the Research and Development Large Projects (7). This plan addresses the DOE quality assurance requirements of 10 CFR 830.120, "Quality Assurance." The plan also describes U.S. Home Team quality commitments to the ITER Quality Assurance Program. The ITER Quality Assurance Program is based on the principles described in the International Atomic Energy Agency Standard No. 50-C-QA, "Quality Assurance for Safety in Nuclear Power Plants and Other Nuclear Facilities." Each commitment is supported with preferred implementation methodology that will be used in evaluating the task quality plans to be submitted by the Performing Institutions. The implementing provisions of the program are based on guidance provided in American National Standards Institute/American Society of Mechanical Engineers NQA-1 1994, "Quality Assurance." The individual Performing Institutions will implement the appropriate quality program provisions through their own established quality plans that have been reviewed and found to comply with U.S. Home Team quality assurance plan commitments to the ITER Quality Assurance Program. The extent of quality program provisions

  16. Commission for the Accreditation of Birth Centers

    Science.gov (United States)

    ... Learning Login: Commissioners Birth Centers CABC Learning Place Home Accredited Birth Centers Find CABC Accredited Birth Centers What does ... In the Pursuit of Excellence You are here: Home In the ... for the Accreditation of Birth Centers (CABC) provides support, education, and accreditation to ...

  17. Child Home Care Allowance and the Transition to Second- and Third-Order Births in Finland

    OpenAIRE

    Erlandsson, Anni

    2017-01-01

    Using register data from the Finnish Census Panel, this paper studies the relationship between the use of the child home care allowance and second and third births among women aged 20?44 in Finland during the period 1992?2007. Discrete-time event-history analysis is applied to examine (i) whether women taking up the child home care allowance while their previous child was under the age of 3 have a higher risk to proceed to subsequent childbearing, (ii) whether these women proceed to a further...

  18. Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes.

    Science.gov (United States)

    Benyshek, Daniel C; Cheyney, Melissa; Brown, Jennifer; Bovbjerg, Marit L

    2018-05-02

    Limited systematic research on maternal placentophagy is available to maternity care providers whose clients/patients may be considering this increasingly popular practice. Our purpose was to characterize the practice of placentophagy and its attendant neonatal outcomes among a large sample of women in the United States. We used a medical records-based data set (n = 23 242) containing pregnancy, birth, and postpartum information for women who planned community births. We used logistic regression to determine demographic and clinical predictors of placentophagy. Finally, we compared neonatal outcomes (hospitalization, neonatal intensive unit admission, or neonatal death in the first 6 weeks) between placenta consumers and nonconsumers, and participants who consumed placenta raw vs cooked. Nearly one-third (31.2%) of women consumed their placenta. Consumers were more likely to have reported pregravid anxiety or depression compared with nonconsumers. Most (85.7%) placentophagic mothers consumed their placentas in encapsulated form, and nearly half (49.1%) consumed capsules containing dehydrated, uncooked placenta. Placentophagy was not associated with any adverse neonatal outcomes. Women with home births were more likely to engage in placentophagy than women with birth center births. The most common reason given (58.6%) for engaging in placentophagy was to prevent postpartum depression. The majority of women consumed their placentas in uncooked/encapsulated form and hoping to avoid postpartum depression, although no evidence currently exists to support this strategy. Preparation technique (cooked vs uncooked) did not influence adverse neonatal outcomes. Maternity care providers should discuss the range of options available to prevent/treat postpartum depression, in addition to current evidence with respect to the safety of placentophagy. © 2018 Wiley Periodicals, Inc.

  19. Born Too Soon: What Can We Expect? Nature of Home Literacy Experiences for Children with Very Low Birth Weight

    Science.gov (United States)

    Ragusa, G.

    2009-01-01

    This study documents the home literacy experiences of children born with very low birth weight (VLBW). The study's design was modelled after Purcell-Gates' study of social domains mediated by print as home literacy experiences. A design combining purposeful sampling, semi-structured data collection and descriptive case study analysis was employed…

  20. Extremely Preterm Birth

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Extremely Preterm Birth Home For Patients Search FAQs Extremely Preterm Birth ... Spanish FAQ173, June 2016 PDF Format Extremely Preterm Birth Pregnancy When is a baby considered “preterm” or “ ...

  1. How Home Health Nurses Plan Their Work Schedules: A Qualitative Descriptive Study.

    Science.gov (United States)

    Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

    2018-06-12

    To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process. Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting. Qualitative descriptive design. Semi-structured interviews were conducted with 20 registered nurses who had greater than 2 years of experience in home health and were employed by one of the three participating home health agencies in the mid-Atlantic region of the United States. Data were analyzed using conventional content analysis. Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritize visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients. Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments. Home health nurses plan their work schedules to provide high quality care that is patient-centered and timely. The findings also highlight organizational priorities to facilitate continuity of care and support nurses while alleviating the burnout

  2. Advance care planning for nursing home residents with dementia: policy vs. practice.

    Science.gov (United States)

    Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

    2016-03-01

    The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

  3. Care Plan Improvement in Nursing Homes: An Integrative Review.

    Science.gov (United States)

    Mariani, Elena; Chattat, Rabih; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne

    2017-01-01

    Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur. The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.

  4. A Pleasing Birth

    NARCIS (Netherlands)

    Vries, De Raymond

    2005-01-01

    Women have long searched for a pleasing birth-a birth with a minimum of fear and pain, in the company of supportive family, friends, and caregivers, a birth that ends with a healthy mother and baby gazing into each other's eyes. For women in the Netherlands, such a birth is defined as one at home

  5. Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland.

    Science.gov (United States)

    Whitford, Heather M; Entwistle, Vikki A; van Teijlingen, Edwin; Aitchison, Patricia E; Davidson, Tracey; Humphrey, Tracy; Tucker, Janet S

    2014-09-01

    Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or "outside" formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record. Exploratory qualitative interviews were conducted with women (42) and maternity service staff (24) in northeast Scotland. Data were analyzed thematically. Staff and women were generally positive about the provision of the birth plan section within the record. Perceived benefits included the opportunity to highlight preferences, enhance communication, stimulate discussions, and address anxieties. However, not all women experienced these benefits or understood the birth plan's purpose. Some were unaware of the opportunity to complete it or could not access the support they needed from staff to discuss or be confident about their options. Some were reluctant to plan too much. Staff recognized the need to support women with birth plan completion but noted practical challenges to this. A supportive antenatal opportunity to allow discussion of options may be needed to realize the potential benefits of routine inclusion of birth plans in maternity notes. © 2014 Wiley Periodicals, Inc.

  6. Intrapartum and Postpartum Transfers to a Tertiary Care Hospital from Out-of-Hospital Birth Settings: A Retrospective Case Series.

    Science.gov (United States)

    Lundeen, Tiffany

    2016-01-01

    This study describes the reasons for and outcomes of maternal transfers from private homes and freestanding birthing suites to a large academic hospital in order to better understand and meet the needs of transferring women and their families. The convenience sample included all adult women admitted to the labor and birth unit or emergency room within a 5-year period who: 1) had planned to give birth out-of-hospital but developed complications at term before the onset of labor and were admitted to the hospital for labor induction; 2) had planned to give birth at home or in a birthing suite but transferred to the hospital during labor; or 3) arrived at the hospital for care within 24 hours after a planned birth at home or in a birthing suite. Descriptive data for each transfer were obtained from the medical record. Fifty-one transfers were identified: 11 prior to labor, 38 during labor, and 2 postpartum. Only 4 transfers were considered urgent by the referring provider. The most common reasons for intrapartum transfer were prolonged labor (n = 19) and desire for epidural analgesia (n = 10). Only 25% of the medical records had documentation that the referring provider accompanied the woman to the hospital during the care transition or was involved in her hospital course; however, the prenatal and/or intrapartum records had been delivered by the referring provider, were referenced in the hospital admission note, and had become part of the permanent hospital medical record for 85% of the women. On average, one transfer per year was complicated by neonatal morbidity, and one transfer per year involved significant disagreement between hospital providers and the women presenting for care. Collecting and reviewing data about a facility's perinatal transfer events can help the local multi-stakeholder group appraise current practice and plan for quality improvement. © 2016 by the American College of Nurse-Midwives.

  7. Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration.

    Science.gov (United States)

    Sarker, Bidhan Krishna; Rahman, Musfikur; Rahman, Tawhidur; Hossain, Jahangir; Reichenbach, Laura; Mitra, Dipak Kumar

    2016-01-01

    Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA) in rural areas of Bangladesh. This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII) with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI) with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community. The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities. The study findings provide us a better understanding of the reasons for preference for home delivery with TBA among this

  8. Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs in Rural Bangladesh: A Qualitative Exploration.

    Directory of Open Access Journals (Sweden)

    Bidhan Krishna Sarker

    Full Text Available Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA in rural areas of Bangladesh.This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community.The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities.The study findings provide us a better understanding of the reasons for preference for home delivery with TBA

  9. The Effect of Integrating Family Planning with a Maternal and Newborn Health Program on Postpartum Contraceptive Use and Optimal Birth Spacing in Rural Bangladesh.

    Science.gov (United States)

    Ahmed, Saifuddin; Ahmed, Salahuddin; McKaig, Catharine; Begum, Nazma; Mungia, Jaime; Norton, Maureen; Baqui, Abdullah H

    2015-09-01

    Meeting postpartum contraceptive need remains a major challenge in developing countries, where the majority of women deliver at home. Using a quasi-experimental trial design, we examine the effect of integrating family planning (FP) with a community-based maternal and newborn health (MNH) program on improving postpartum contraceptive use and reducing short birth intervals MNH activities in the intervention arm, but provided only MNH services in the control arm. The contraceptive prevalence rate (CPR) in the intervention arm was 15 percent higher than in the control arm at 12 months, and the difference in CPRs remained statistically significant throughout the 24 months of observation. The short birth interval of less than 24 months was significantly lower in the intervention arm. The study demonstrates that it is feasible and effective to integrate FP services into a community-based MNH care program for improving postpartum contraceptive use and lengthening birth intervals. © 2015 The Population Council, Inc.

  10. Birth environment facilitation by midwives assisting in non-hospital births: a qualitative interview study.

    Science.gov (United States)

    Igarashi, Toshiko; Wakita, Mariko; Miyazaki, Kikuko; Nakayama, Takeo

    2014-07-01

    midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved. semi-structured qualitative interview study and constant comparative analysis. 14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births. Osaka, Kyoto, Nara, and Shiga, Japan. midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper. independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Asymptomatic urinary tract infection among pregnant women receiving ante-natal care in a traditional birth home in Benin City, Nigeria.

    Science.gov (United States)

    Oladeinde, Bankole H; Omoregie, Richard; Oladeinde, Oladapo B

    2015-01-01

    A good proportion of pregnant women patronize traditional birth homes in Nigeria for ante-natal care. This study aimed at determining the prevalence, risk factors, and susceptibility profile of etiologic agents of urinary tract infection among ante-natal attendees in a traditional birth home in Benin City, Nigeria. Clean-catch urine was collected from 220 pregnant women attending a traditional birth home in Benin City, Nigeria. Urine samples were processed, and microbial isolates identified using standard bacteriological procedures. A cross-sectional study design was used. The prevalence of urinary tract infection among pregnant women was 55.0%, significantly affected by parity and gestational age (Pinfection was recorded among 13(10.7%) pregnant women, and was unaffected by maternal age, parity, gravidity, gestational age, and educational status. Irrespective of trimester Escherichia coli was the most prevalent etiologic agent of urinary tract infection, followed by Staphylococcus aureus. The flouroquinolones were the most effective antibacterial agents, while Sulphamethoxazole-trimetoprim, Amoxicillin, Nalidixic acid, and Nitrofurantoin had poor activity against uropathogens isolated. The prevalence of urinary tract infection among pregnant women was 55.0% and significantly affected by gestational age and parity. The most prevalent etiologic agent observed was Escherichia coli. With the exception of the flouroquinolones, aminoglycoside, and Amoxicillin-cluvanate, the activity of other antibiotics used on uropathogens were poor. Health education of the traditional birth attendant and her clients by relevant intervention agencies is strongly advocated.

  12. Home and parenting resources available to siblings depending on their birth intention status.

    Science.gov (United States)

    Barber, Jennifer S; East, Patricia L

    2009-01-01

    This study examines the differential availability of family and parenting resources to children depending on their birth planning status. The National Longitudinal Survey of Youth data were analyzed, 3,134 mothers and their 5,890 children (M = 7.1 years, range = 1 month-14.8 years), of whom 63% were intended at conception, 27% were mistimed, and 10% were unwanted. Fixed-effects models show that unwanted and mistimed children had fewer resources than intended siblings. Parents' emotional resources to older children decreased after the birth of a mistimed sibling. Findings suggest that cognitive and emotional resources are differentially available to children within a family depending on intention status and that unintended births lead to decreased parental resources for older children in the household.

  13. "Natural family planning": effective birth control supported by the Catholic Church.

    OpenAIRE

    Ryder, R E

    1993-01-01

    During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to birth control and therefore as a particular threat. This was based on the notion that the only method of birth control approved by the church--natural family planning--is unreliable, unacceptable, and ineffective. In the 20 years since E L Billings and co...

  14. Asthma diagnosis in a child and cessation of smoking in the child's home : the PIAMA birth cohort

    NARCIS (Netherlands)

    Wijga, Alet H; Schipper, Maarten; Brunekreef, Bert; Koppelman, Gerard H; Gehring, Ulrike

    Second hand smoke (SHS) exposure is associated with increased incidence and severity of childhood asthma. We investigated whether, in turn, asthma diagnosis in a child is associated with cessation of smoking exposure in the child's home. In the PIAMA birth cohort (n=3963), parents reported on

  15. Asthma diagnosis in a child and cessation of smoking in the child's home : the PIAMA birth cohort

    NARCIS (Netherlands)

    Wijga, Alet H.; Schipper, Maarten; Brunekreef, Bert; Koppelman, Gerard H.; Gehring, Ulrike

    2017-01-01

    Second hand smoke (SHS) exposure is associated with increased incidence and severity of childhood asthma. We investigated whether, in turn, asthma diagnosis in a child is associated with cessation of smoking exposure in the child's home. In the PIAMA birth cohort (n = 3963), parents reported on

  16. Where Do You Feel Safest? Demographic Factors and Place of Birth.

    Science.gov (United States)

    Sperlich, Mickey; Gabriel, Cynthia; Seng, Julia

    2017-01-01

    The vast majority of planned out-of-hospital births in the United States occur among white women; no study has addressed whether black women prefer out-of-hospital birth less or whether this racial disparity is due to other causes such as constrained access. This study sought to answer the question of whether white and black women feel safest giving birth in out-of-hospital settings at different rates and whether this answer is associated with other socioeconomic indicators. An interview of 634 nulliparous women during the third trimester of their pregnancy in Michigan provided data regarding where women felt safest giving birth. Feeling safest giving birth out-of-hospital was examined in relation to socioeconomic factors including race, age, household income, education, residence in a high-crime neighborhood, partnered status, and type of insurance. This study found that black and white women say they feel safest giving birth in out-of-hospital settings at similar rates (11.5% and 13.1%, respectively). Logistic regression results showed that poverty and having education beyond high school were the only sociodemographic indicators significantly associated with feeling safest giving birth out-of-hospital. Disparities evident in planned home birth and birth center rates cannot be explained by racial differences in feelings toward out-of-hospital birth and should be addressed more specifically in public policy and future studies. © 2016 by the American College of Nurse-Midwives.

  17. In-home HIV testing and nevirapine dosing by traditional birth attendants in rural Zambia: a feasibility study.

    Science.gov (United States)

    Brennan, Alana T; Thea, Donald M; Semrau, Katherine; Goggin, Caitlin; Scott, Nancy; Pilingana, Portipher; Botha, Belinda; Mazimba, Arthur; Hamomba, Leoda; Seidenberg, Phil

    2014-01-01

    Access to lifesaving prevention of mother-to-child transmission (PMTCT) services is problematic in rural Zambia. The simplest intervention used in Zambia has been 2-dose nevirapine (NVP) administration in the peripartum period, a regimen of 1 NVP tablet to the mother at the onset of labor and 1 dose in the form of syrup to the newborn within 4 to 72 hours after birth. This 2-dose regimen has been shown to reduce MTCT by nearly 50%. We set out to demonstrate that in-home HIV testing and NVP dosing by traditional birth attendants (TBAs) is feasible and acceptable by women in rural Zambia. This was a pilot program using TBAs to perform rapid saliva-based HIV testing and administer single-dose NVP in tablet form to the mother at the onset of labor and syrup to the infant after birth. A total of 280 pregnant women were consented and enrolled into the program, of whom 124 (44.3%) gave birth at home with the assistance of a trained TBA. Of those, 16 (12.9%) were known to be HIV positive, and 101 of the remaining 108 (93.5%) accepted a rapid HIV test. All these women tested HIV negative. In the subset of 16 mothers who were HIV positive, 13 (81.3%) took single-dose NVP administered by a TBA between 1 and 24 hours prior to birth and 100% of exposed newborns (16 of 16) received NVP syrup within 72 hours after birth, 80% of whom were dosed in the first 24 hours of life. With the substantial shortage of human resources in public health care throughout sub-Saharan Africa, it is extremely valuable to utilize lay health care workers to help extended services beyond the level of the facility. Given the high uptake of PMTCT services we believe that TBAs with proper training and support can successfully provide country-approved PMTCT. © 2013 by the American College of Nurse-Midwives.

  18. Traditional birth attendants issue: a menace in developing countries.

    Science.gov (United States)

    Buowari, O Y

    2012-01-01

    A significant proportion of births in Nigeria still occur at homes of traditional birth attendant. Traditional birth attendants are popular in developing and low resource countries. They lack no formal education or medical training and their clients end up with obstetric complications which lead to severe morbidity and mortality. Two cases of pregnant women that engaged the services of traditional birth attendants (TBA) before presenting at a health facility are presented. They ended up with severe morbidity and mortalities. A 29 year old gravida 3 + para 2+0 woman with two previous caesarean section(C/S) was counselled for elective c/s but declined. She presented at the home of a TBA, had spontaneous vagina deliver, collapsed one hour after delivery and was dead by the time she was brought to the hospital. A 30 year old gravida 10 para 7 + 3 presented in hospital after being in labour at the home of a TBA for three days. On presentation in hospital there was absent foetal heart sound. At surgery there was ruptured uterus and subtotal hysterectomy was done. To improve the situation better access to optimal antenatal care and intrapartum care together with early referral of high-risk patients must be facilitated. Increased community awareness, promotion of appropriate technology for effective health care planning strategy from the grassroots level to tertiary centres is important in the reduction of obstructed labour. One of the most effective means of reducing maternal mortality is the provision of caesarean section for all women who need it.

  19. Women's motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis.

    Science.gov (United States)

    Hollander, Martine; de Miranda, Esteriek; van Dillen, Jeroen; de Graaf, Irene; Vandenbussche, Frank; Holten, Lianne

    2017-12-16

    Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. Until now there were no qualitative data on women's motivations for these choices in the Dutch maternity care system where integrated midwifery care and home birth are regular options in low risk pregnancies. We aimed to examine women's motivations for birthing outside the system in order to provide medical professionals with insight and recommendations regarding their interactions with women who have birth wishes that go against medical advice. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with 28 women on their motivations for going against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. A focus group was held for a member check of the findings. Four main themes were found: 1) Discrepancy in the definition of superior knowledge, 2) Need for autonomy and trust in the birth process, 3) Conflict during negotiation of the birth plan, and 4) Search for different care. One overarching theme emerged that covered all other themes: Fear. This theme refers both to the participants' fear (of interventions and negative consequences of their choices) and to the providers' fear (of a bad outcome). Where for some women it was a positive choice, for the majority of women in this study the choice for a home birth in a high risk pregnancy or an unassisted childbirth was a negative one. Negative choices were due to previous or current negative experiences with maternity care and/or conflict surrounding the birth plan. The main goal of working with women whose birthing choices do not align with medical advice should not be to coerce them into the framework of protocols and guidelines but to prevent negative choices. Recommendations for maternity caregivers can be summarized as

  20. Community-based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural Ghana.

    Science.gov (United States)

    Geller, S; Carnahan, L; Akosah, E; Asare, G; Agyemang, R; Dickson, R; Kapungu, C; Owusu-Ansah, L; Robinson, N; Mensah-Homiah, J

    2014-02-01

    To report on a rigorous distribution and monitoring plan to track misoprostol for community-based distribution to reduce postpartum haemorrhage (PPH) in rural Ghana. Operations research. Rural Ghana. Women in third trimester of pregnancy presenting to primary health centres (PHCs) for antenatal care (ANC). Ghana Health Service (GHS), Millennium Village Projects, and the University of Illinois at Chicago conducted an operations research study designed to assess the safety, feasibility, and acceptability of community-based distribution of misoprostol to prevent PPH at home deliveries in rural Ghana. One thousand doses (3000 tablets, 200 μg each) were obtained from the Family Health Division of GHS. Three 200-μg tablets of misoprostol (600 μg) in foil packets were packaged together in secured transparent plastic packets labelled with pictorial messages and distributed to midwives at seven PHCs for distribution to pregnant women. Correct use of misoprostol in home deliveries and retrieval of unused misoprostol doses, PPH rates and maternal mortality. Of the 999 doses distributed to midwives, 982 (98.3%) were successfully tracked, with a 1.7% lost to follow-up rate. Midwives distributed 654 doses to women at third-trimester ANC visits. Of women who had misoprostol to use at home, 81% had an institutional delivery and were able to return the misoprostol safely to the midwife. Of the women that used misoprostol, 99% used the misoprostol correctly. This study clearly demonstrates that misoprostol distributed antenatally to pregnant women can be used accurately and reliably by rural Ghanaian women, and should be considered for policy implementation across Ghana and other countries with high home birth rates and maternal mortality ratios. © 2013 Royal College of Obstetricians and Gynaecologists.

  1. Care planning at home: a way to increase the influence of older people?

    Directory of Open Access Journals (Sweden)

    Helene Berglund

    2012-08-01

    Full Text Available Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people's influence is an important and required aspect of these practices. This study's objective was to describe and analyse older people's influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older people's homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed.  Results: Care-planning meetings at home appeared to enable older people's involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised.  Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people's opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.

  2. Effect of Implementing a Birth Plan on Womens' Childbirth Experiences and Maternal & Neonatal Outcomes

    Science.gov (United States)

    Farahat, Amal Hussain; Mohamed, Hanan El Sayed; Elkader, Shadia Abd; El-Nemer, Amina

    2015-01-01

    Childbirth satisfaction represents a sense of feeling good about one's birth. It is thought to result from having a sense of control, having expectations met, feeling empowered, confident and supported. The aim of this study was to implement a birth plan and evaluate its effect on women's childbirth experiences and maternal, neonatal outcomes. A…

  3. Prevalence of Malaria and Anemia among Pregnant Women Attending a Traditional Birth Home in Benin City, Nigeria

    Directory of Open Access Journals (Sweden)

    Bankole Henry Oladeinde

    2012-05-01

    Full Text Available Objectives: To determine the prevalence of malaria and anemia among pregnant women attending a traditional birth center as well as the effect of herbal remedies, gravidity, age, educational background and malaria prevention methods on their prevalence.Methods: Blood specimens were collected from 119 pregnant women attending a Traditional Birth Home in Benin City, Nigeria. Malaria parasitemia was diagnosed by microscopy while anemia was defined as hemoglobin concentration <11 g/dL.Results: The prevalence of malaria infection was (OR=4.35 95% CI=1.213, 15.600; p=0.016 higher among primigravidae (92.1%. Pregnant women (38.5% with tertiary level of education had significantly lower prevalence of malaria infection (p=0.002. Malaria significantly affected the prevalence of anemia (p<0.05. Anemia was associated with consumption of herbal remedies (OR=2.973; 95% CI=1.206, 7.330; p=0.017. The prevalence of malaria parasitemia and anemia were not affected by malaria prevention methods used by the participants.Conclusion: The overall prevalence of malaria infection and anemia observed in this study were 78.9% and 46.2%, respectively. Higher prevalence of malaria infection was associated with primigravidae and lower prevalence with tertiary education of subjects. Anemia was associated with consumption of herbal remedies. There is urgent need to control the prevalence of malaria and anemia among pregnant women attending traditional birth homes.

  4. How to value patient values: Cesarean sections for the periviable fetus, and home births.

    Science.gov (United States)

    Minkoff, Howard; Atallah, Fouad

    2018-02-01

    Respect for patient autonomy involves providing sufficient information to patients to allow them to make informed decisions, and then honoring their requests unless they are unethical or futile. At times, the factors that patients consider may not be purely biologic ones but rather will include "spiritual" factors (a sense of control in a home birth). When patients balance biologic risks against spiritual gain, physicians may not be comfortable giving deference to patients' choice. In order to explicate this issue we explore two clinical scenarios: home birth, and cesarean section for a periviable fetus; and we consider futility and limits on affirmative autonomy. We argue that bodily integrity must remain inviolate. However, conversations regarding a patient's affirmative rights invoke the moral agency of both patient and provider. Those conversations must include considerations of patient values as well as medical facts. Physicians' values are also part of counseling, but they are appropriately considered only when they are medical values (beneficence, truth telling), not personal beliefs (e.g., children with impairments should have, or not have, a 'do not resuscitate' order). Physicians have the right to refuse to participate if they think that the biologic risk overwhelms a potential value-based benefit, but they should be loath to do so if the balance is anywhere close to equipoise, and the patient's values are deeply held. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

    Science.gov (United States)

    MacDorman, Marian F; Declercq, Eugene

    2016-06-01

    Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

  6. The effect of environmental tobacco smoke during pregnancy on birth weight.

    Science.gov (United States)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F; Wachmann, Henrik; Ottesen, Bent

    2006-01-01

    This study explores whether pregnant nonsmokers' exposure to environmental tobacco smoke (ETS) affects the average birth weight at term. The population studied consists of pregnant nonsmokers participating in a study called Smoke-free Newborn Study. The participants (n = 1612) answered a questionnaire during 12th to 16th gestational week about their exposure to ETS at home and outside the home. Pregnant nonsmokers exposed to ETS both at home and outside the home gave birth to children with a birth weight of 78.9 g (95% CI -143.7 to -14.1) (P=0.02) lower than the weight of children born to women unexposed to ETS. There was no significant reduction in birth weight among women exposed to ETS at home only or outside the home only. A nonsignificant dose-response association was seen between increasing daily exposure to ETS and reduction in birth weight. Nonsmoking pregnant women who were exposed to ETS at home as well as outside the home gave birth to children with a 79 g reduction in birth weight compared to children of unexposed women. The fact that exposure to ETS has an effect on the birth weight is regarded as essential. The authors recommend that pregnant women should not be exposed to passive smoking, and that it should be considered whether workplace legislation should be instituted in order to protect pregnant women against the adverse effects of passive smoking.

  7. "Natural family planning": effective birth control supported by the Catholic Church.

    Science.gov (United States)

    Ryder, R E

    1993-09-18

    During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to birth control and therefore as a particular threat. This was based on the notion that the only method of birth control approved by the church--natural family planning--is unreliable, unacceptable, and ineffective. In the 20 years since E L Billings and colleagues first described the cervical mucus symptoms associated with ovulation natural family planning has incorporated these symptoms and advanced considerably. Ultrasonography shows that the symptoms identify ovulation precisely. According to the World Health Organisation, 93% of women everywhere can identify the symptoms, which distinguish adequately between the fertile and infertile phases of the menstrual cycle. Most pregnancies during trials of natural family planning occur after intercourse at times recognised by couples as fertile. Thus pregnancy rates have depended on the motivation of couples. Increasingly studies show that rates equivalent to those with other contraceptive methods are readily achieved in the developed and developing worlds. Indeed, a study of 19,843 poor women in India had a pregnancy rate approaching zero. Natural family planning is cheap, effective, without side effects, and may be particularly acceptable to the efficacious among people in areas of poverty.

  8. Poor thermal care practices among home births in Nepal: further analysis of Nepal Demographic and Health Survey 2011.

    Science.gov (United States)

    Khanal, Vishnu; Gavidia, Tania; Adhikari, Mandira; Mishra, Shiva Raj; Karkee, Rajendra

    2014-01-01

    Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving 'optimum thermal care' among home born newborns of Nepal. Data from the Nepal Demographic and Health Surveys (NDHS) 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression. A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9%)) newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976)), attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017)), and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323)) were likely to receive optimum thermal care. The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal.

  9. Poor thermal care practices among home births in Nepal: further analysis of Nepal Demographic and Health Survey 2011.

    Directory of Open Access Journals (Sweden)

    Vishnu Khanal

    Full Text Available INTRODUCTION: Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving 'optimum thermal care' among home born newborns of Nepal. METHODS: Data from the Nepal Demographic and Health Surveys (NDHS 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression. RESULTS: A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9% newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976, attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017, and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323 were likely to receive optimum thermal care. CONCLUSION: The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal.

  10. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

    OpenAIRE

    Smith, Jeffrey Michael; Gubin, Rehana; Holston, Martine M; Fullerton, Judith; Prata, Ndola

    2013-01-01

    Abstract Background Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. Metho...

  11. Delivery practices of traditional birth attendants in Dhaka slums, Bangladesh.

    Science.gov (United States)

    Fronczak, N; Arifeen, S E; Moran, A C; Caulfield, L E; Baqui, A H

    2007-12-01

    This paper describes associations among delivery-location, training of birth attendants, birthing practices, and early postpartum morbidity in women in slum areas of Dhaka, Bangladesh. During November 1993-May 1995, data on delivery-location, training of birth attendants, birthing practices, delivery-related complications, and postpartum morbidity were collected through interviews with 1,506 women, 489 home-based birth attendants, and audits in 20 facilities where the women from this study gave birth. Associations among maternal characteristics, birth practices, delivery-location, and early postpartum morbidity were specifically explored. Self-reported postpartum morbidity was associated with maternal characteristics, delivery-related complications, and some birthing practices. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birth-location. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity.

  12. Access to the Birth Control Pill and the Career Plans of Young Men and Women

    DEFF Research Database (Denmark)

    Steingrimsdottir, Herdis

    The paper explores the effect of unrestricted access to the birth control pill on young people’s career plans, using annual surveys of college freshmen from 1968 to 1980. In particular it addresses the question of who was affected by the introduction of the birth control pill by looking at career...

  13. The influence of preferred place of birth on the course of pregnancy and labor among healthy nulliparous women: a prospective cohort study.

    Science.gov (United States)

    van Haaren-ten Haken, Tamar M; Hendrix, Marijke; Smits, Luc J; Nieuwenhuijze, Marianne J; Severens, Johan L; de Vries, Raymond G; Nijhuis, Jan G

    2015-02-14

    Most studies on birth settings investigate the association between planned place of birth at the start of labor and birth outcomes and intervention rates. To optimize maternity care it also is important to pay attention to the entire process of pregnancy and childbirth. This study explores the association between the initial preferred place of birth and model of care, and the course of pregnancy and labor in low-risk nulliparous women in the Netherlands. As part of a Dutch prospective cohort study (2007-2011), we compared medical indications during pregnancy and birth outcomes of 576 women who initially preferred a home birth (n = 226), a midwife-led hospital birth (n = 168) or an obstetrician-led hospital birth (n = 182). Data were obtained by a questionnaire before 20 weeks of gestation and by medical records. Analyses were performed according to the initial preferred place of birth. Low-risk nulliparous women who preferred a home birth with midwife-led care were less likely to be diagnosed with a medical indication during pregnancy compared to women who preferred a birth with obstetrician-led care (OR 0.41 95% CI 0.25-0.66). Preferring a birth with midwife-led care - both at home and in hospital - was associated with lower odds of induced labor (OR 0.51 95% CI 0.28-0.95 respectively OR 0.42 95% CI 0.21-0.85) and epidural analgesia (OR 0.32 95% CI 0.18-0.56 respectively OR 0.34 95% CI 0.19-0.62) compared to preferring a birth with obstetrician-led care. In addition, women who preferred a home birth were less likely to experience augmentation of labor (OR 0.54 95% CI 0.32-0.93) and narcotic analgesia (OR 0.41 95% CI 0.21-0.79) compared to women who preferred a birth with obstetrician-led care. We observed no significant association between preferred place of birth and mode of birth. Nulliparous women who initially preferred a home birth were less likely to be diagnosed with a medical indication during pregnancy. Women who initially preferred a birth

  14. The birth and routinization of IVF in China

    DEFF Research Database (Denmark)

    Wahlberg, Ayo

    2016-01-01

    How can it be that China today is home to some of the world’s largest IVF clinics, carrying out as many as 30,000 cycles annually? In this article, I address how IVF was developed in China during the early 1980s only to be routinized during the exact same period that one of the world’s most...... comprehensive family planning programmes aimed at preventing birth was being rolled out. IVF was not merely imported into China, rather it was experimentally developed within China into a form suitable for its restrictive family planning regulations. As a result, IVF and other assisted reproductive technologies...

  15. The SMILE Program: Does Timing and Dosing of Nurse Home Visits Matter in Reducing Adverse Birth Outcomes for African American Women

    Science.gov (United States)

    2013-03-13

    aspiration, prenatal drug exposure, anemia , sickle cell trait, or identification of any other adverse health condition to include premature birth...p=.840), preeclampsia (LBW: χ 2 = .034, df= 1, p=.967; Premature: χ 2 =.087, df= 1, p=.920), placenta previa (LBW: χ 2 = .173, df= 1, p=.845...interdisciplinary approaches to research and practice (1st ed.). San Francisco, CA: Jossey-Bass. HOME VISITATION & BIRTH OUTCOMES 29 Fry-Johnson, Y . W

  16. [Attitudes and habits of Canadians in relation to planning and preparing meals at home].

    Science.gov (United States)

    Aubé, Julie; Marquis, Marie

    2011-01-01

    To describe the attitudes and habits of Canadians in relation to planning and preparing meals at home, in order to identify motivations that can be used to promote home cooking. An electronic survey consisting of 39 multiple-choice questions was posted on the Dietitians of Canada website between November 16 and December 22, 2006. The statements analyzed have to do with perceived benefits associated with home cooking, obstacles preventing people from cooking, preparation time and meal planning, learning to cook, and sources of recipe ideas. A total of 4,080 people filled out the questionnaire. Although they believe that home cooking can improve diet quality and eating behaviours, respondents experience several obstacles relating to day-to-day food preparation. Among these are lack of time, energy, ideas, and planning. This study underlines the relevance of creating strategies not only for educating consumers about the benefits of home cooking, but also for providing practical information to help them overcome obstacles limiting the day-to-day preparation of food.

  17. Home Birth: Know the Pros and Cons

    Science.gov (United States)

    ... including: A desire to give birth without medical intervention, such as pain medication, labor augmentation, labor induction or fetal heart rate monitoring A desire to give birth in a comfortable, familiar place surrounded by family Dissatisfaction with hospital care ...

  18. Home and Parenting Resources Available to Siblings Depending on Their Birth Intention Status

    Science.gov (United States)

    Barber, Jennifer S.; East, Patricia L.

    2009-01-01

    This study examines the differential availability of family and parenting resources to children depending on their birth planning status. The National Longitudinal Survey of Youth data were analyzed, 3,134 mothers and their 5,890 children (M = 7.1 years, range = 1 month-14.8 years), of whom 63% were intended at conception, 27% were mistimed, and…

  19. Recent Trends in Out-of-Hospital Births in the United States.

    Science.gov (United States)

    MacDorman, Marian F; Declercq, Eugene; Mathews, T J

    2013-01-01

    Although out-of-hospital births are still relatively rare in the United States, it is important to monitor trends in these births, as they can affect patterns of facility usage, clinician training, and resource allocation, as well as health care costs. Trends and characteristics of home and birth center births are analyzed to more completely profile contemporary out-of-hospital births in the United States. National birth certificate data were used to examine a recent increase in out-of-hospital births. After a gradual decline from 1990 to 2004, the number of out-of-hospital births increased from 35,578 in 2004 to 47,028 in 2010. In 2010, 1 in 85 US infants (1.18%) was born outside a hospital; about two-thirds of these were born at home, and most of the rest were born in birth centers. The proportion of home births increased by 41%, from 0.56% in 2004 to 0.79% in 2010, with 10% of that increase occurring in the last year. The proportion of birth center births increased by 43%, from 0.23% in 2004 to 0.33% in 2010, with 14% of the increase in the last year. About 90% of the total increase in out-of hospital births from 2004 to 2010 was a result of increases among non-Hispanic white women, and 1 in 57 births to non-Hispanic white women (1.75%) in 2010 was an out-of-hospital birth. Most home and birth center births were attended by midwives. Home and birth center births in the United States are increasing, and the rate of out-of-hospital births is now at the highest level since 1978. There has been a decline in the risk profile of out-of-hospital births, with a smaller proportion of out-of-hospital births in 2010 than in 2004 occurring to adolescents and unmarried women and fewer preterm, low-birth-weight, and multiple births. © 2013 This article is a U.S. Government work and is in the public domain in the United States.

  20. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran

    Directory of Open Access Journals (Sweden)

    Ghazi Tabatabaie Mahmoud

    2012-03-01

    Full Text Available Abstract Background One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings. Methods In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis. Results The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral. Conclusions Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central

  1. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran

    Science.gov (United States)

    2012-01-01

    Background One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings. Methods In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO) standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis. Results The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral. Conclusions Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use

  2. Home-based radiology transcription and a productivity pay plan.

    Science.gov (United States)

    Kerr, K

    1997-01-01

    Shands Hospital in Gainesville, Fla., decided to evaluate the way it provided transcription services in its radiology department. It identified four goals: increased productivity, decreased operating expense, finding much needed space in the radiology department and increasing employee morale. The department performs 165,000 procedures annually, with 66 radiologists, 29 faculty, and 37 residents and fellows on staff. Six FTEs comprised the transcription pool in the radiology department, with transcription their only duty. Transcriptionists were paid an hourly rate based on their years of service, not their productivity. Evaluation and measurement studies were undertaken by the hospital's management systems engineering department. The transcriptionists' hours were then changed to provide coverage during the periods of heaviest dictation. The productivity level of the transcription staff was also measured and various methods of measurement reviewed. The goal was a pure incentive pay plan that would reward employees for every increase in productivity. The incentive pay plan was phased in over a three-month period. Transcriptionists were paid for work performed, with no base pay beyond minimum wage. The move to home-based transcription was planned. The necessary equipment was identified and various issues specific to working at home were addressed. Approximately six months later, the transcriptionists were set up to work at home. The astounding results achieved are presented: 28% increase in productivity, operational cost savings exceeding $25,000 and a space savings of 238 square feet.

  3. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia.

    Science.gov (United States)

    Titaley, Christiana R; Hunter, Cynthia L; Dibley, Michael J; Heywood, Peter

    2010-08-11

    Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. A qualitative study using focus group discussions (FGDs) and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery. The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services. A comprehensive strategy to increase the availability, accessibility, and affordability of delivery care services should be considered in these West Java

  4. Home energy rating system business plan feasibility study in Washington state

    Energy Technology Data Exchange (ETDEWEB)

    Lineham, T.

    1995-03-01

    In the Fall of 1993, the Washington State Energy Office funded the Washington Home Energy Rating System project to investigate the benefits of a Washington state HERS. WSEO established a HERS and EEM Advisory Group. Composed of mortgage lenders/brokers, realtors, builders, utility staff, remodelers, and other state agency representatives, the Advisory Group met for the first time on November 17, 1993. The Advisory Group established several subcommittees to identify issues and options. During its March 1994 meeting, the Advisory Group formed a consensus directing WSEO to develop a HERS business plan for consideration. The Advisory Group also established a business plan subcommittee to help draft the plan. Under the guidance of the business plan subcommittee, WSEO conducted research on how customers value energy efficiency in the housing market. This plan represents WSEO`s effort to comply with the Advisory Group`s request. Why is a HERS Business Plan necessary? Strictly speaking this plan is more of a feasibility plan than a business plan since it is designed to help determine the feasibility of a new business venture: a statewide home energy rating system. To make this determination decision makers or possible investors require strategic information about the proposed enterprise. Ideally, the plan should anticipate the significant questions parties may want to know. Among other things, this document should establish decision points for action.

  5. Cultures of risk and their influence on birth in rural British Columbia

    Directory of Open Access Journals (Sweden)

    Kornelsen Jude

    2012-11-01

    Full Text Available Abstract Background A significant number of Canadian rural communities offer local maternity services in the absence of caesarean section back-up to parturient residents. These communities are witnessing a high outflow of women leaving to give birth in larger centres to ensure immediate access to the procedure. A minority of women choose to stay in their home communities to give birth in the absence of such access. In this instance, decision-making criteria and conceptions of risk between physicians and parturient women may not align due to the privileging of different risk factors. Methods In-depth qualitative interviews and focus groups with 27 care providers and 43 women from 3 rural communities in B.C. Results When birth was planned locally, physicians expressed an awareness and acceptance of the clinical risk incurred. Likewise, when birth was planned outside the local community, most parturient women expressed an awareness and acceptance of the social risk incurred due to leaving the community. Conclusions The tensions created by these contrasting approaches relate to underlying values and beliefs. As such, an awareness can address the impasse and work to provide a resolution to the competing prioritizations of risk.

  6. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Sapra, Katherine J; Brent, Robert L; Levene, Malcolm I; Arabin, Birgit; Chervenak, Frank A

    2014-10-01

    We examined neonatal mortality in relation to birth settings and birth attendants in the United States from 2006 through 2009. Data from the Centers for Disease Control and Prevention-linked birth and infant death dataset in the United States from 2006 through 2009 were used to assess early and total neonatal mortality for singleton, vertex, and term births without congenital malformations delivered by midwives and physicians in the hospital and midwives and others out of the hospital. Deliveries by hospital midwives served as the reference. Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births. Our study shows a significantly increased total and early neonatal mortality for home births and even higher risks for women of 41 weeks or longer and women having a first birth. These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Evaluation of World Health Organization partograph implementation by midwives for maternity home birth in Medan, Indonesia.

    Science.gov (United States)

    Fahdhy, Mohammad; Chongsuvivatwong, Virasakdi

    2005-12-01

    to assess the effectiveness of promoting the use of the World Health Organization (WHO) partograph by midwives for labour in a maternity home by comparing outcomes after birth. Medan city, North Sumatera Province, Indonesia. 20 midwives who regularly conducted births in maternity homes, randomly allocated into two equal groups. cluster randomised-control trial. under supervision from a team of obstetricians, midwives in the intervention group were introduced to the WHO partograph, trained in its use and instructed to use it in subsequent labours. there were 304 eligible women with vertex presentations among 358 labouring women in the intervention group and 322 among 363 in the control group. Among the intervention group, 304 (92.4%) partographs were correctly completed. From 71 women with the graph beyond the alert line, 42 (65%) were referred to hospital. Introducing the partograph significantly increased referral rate, and reduced the number of vaginal examinations, oxytocin use and obstructed labour. The proportions of caesarean sections and prolonged labour were not significantly reduced. Apgar scores of less than 7 at 1min was reduced significantly, whereas Apgar scores at 5mins and requirement for neonatal resuscitation were not significantly different. Fetal death and early neonatal death rates were too low to compare. a training programme with follow-up supervision and monitoring may be of use when introducing the WHO partograph in other similar settings, and the findings of this study suggest that the appropriate time of referral needs more emphasis in continuing education. the WHO partograph should be promoted for use by midwives who care for labouring women in a maternity home.

  8. "Natural family planning": effective birth control supported by the Catholic Church.

    Science.gov (United States)

    Ryder, R E

    1993-01-01

    During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to birth control and therefore as a particular threat. This was based on the notion that the only method of birth control approved by the church--natural family planning--is unreliable, unacceptable, and ineffective. In the 20 years since E L Billings and colleagues first described the cervical mucus symptoms associated with ovulation natural family planning has incorporated these symptoms and advanced considerably. Ultrasonography shows that the symptoms identify ovulation precisely. According to the World Health Organisation, 93% of women everywhere can identify the symptoms, which distinguish adequately between the fertile and infertile phases of the menstrual cycle. Most pregnancies during trials of natural family planning occur after intercourse at times recognised by couples as fertile. Thus pregnancy rates have depended on the motivation of couples. Increasingly studies show that rates equivalent to those with other contraceptive methods are readily achieved in the developed and developing worlds. Indeed, a study of 19,843 poor women in India had a pregnancy rate approaching zero. Natural family planning is cheap, effective, without side effects, and may be particularly acceptable to the efficacious among people in areas of poverty. Images p724-a p724-b p724-c p724-d p724-e p724-f p724-g PMID:8401097

  9. Controlling networking multimedia appliances: with an open environment - a plan-based approach

    OpenAIRE

    Jantz, D.; Heider, T.

    2000-01-01

    The need for a better user assistance in technical environments led to the birth of a planning assistant. The principal problems in representing real world tasks in this environment of multimedia home devices are explained. A special issue is the developed EMBASSI Generic Architecture to integrate networked multimedia appliances. The planning assistant engages planning algorithms to fullfill user desires without handling traditional technical control interfaces.

  10. Connection, regulation, and care plan innovation: a case study of four nursing homes.

    Science.gov (United States)

    Colón-Emeric, Cathleen S; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L; Corazzini, Kirsten; Anderson, Ruth A

    2006-01-01

    We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of staff connection were associated with higher care plan specificity and innovation. Connection of the frontline nursing staff was crucial for (1) implementation of the formal care plan and (2) spontaneous informal care planning responsive to changing resident needs. Although regulations could theoretically improve cognitive diversity and information flow in care planning, we observed instances of regulatory oversight resulting in less specific care plans and abandonment of an effective care planning process. Interventions which improve staff connectedness may improve resident outcomes.

  11. Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

    Science.gov (United States)

    Goldberg, Elizabeth M.; Trivedi, Amal N.; Mor, Vincent; Jung, Hye-Young; Rahman, Momotazur

    2016-01-01

    The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates. PMID:27516452

  12. Resultado de partos domiciliares atendidos por enfermeiras de 2005 a 2009 em Florianópolis, SC Resultado de partos domiciliares atendidos por enfermeras de 2005 a 2009 en Florianópolis, Sur de Brasil Outcomes of planned home birth assisted by nurses, from 2005 to 2009, in Florianópolis, Brazil

    Directory of Open Access Journals (Sweden)

    Joyce Green Koettker

    2012-08-01

    Full Text Available Estudo transversal sobre resultados obstétricos e neonatais dos partos domiciliares planejados assistidos por enfermeiras obstétricas em Florianópolis, SC. Dados coletados nos prontuários de 100 parturientes assistidas de 2005 a 2009 apontam 11 transferências hospitalares, sendo nove submetidas a cesariana. A maioria das que pariram no domicílio apresentou batimentos cardíacos fetais (94,0% e evolução no partograma normais (61,0%, adotou posição vertical na água, no período expulsivo (71,9%, e os recém-nascidos receberam Apgar do 5° minuto > 7 (98,9%. A frequência de episiotomia foi 1,0%, 49,4% não necessitaram sutura perineal. Os resultados indicam que o parto domiciliar é seguro.Estudio transversal sobre resultados obstétricos y neonatales de los partos domiciliares planificados asistidos por enfermeras obstétricas en Florianópolis, Sur de Brasil. Datos colectados en los prontuarios de 100 parturientas asistidas de 2005 a 2009, señalan 11 transferencias hospitalarias, siendo nueve sometidas a cesárea. La mayoría de las que parieron en el domicilio presentó pulsaciones cardíacas fetales (94,0% y evolución en el partograma normales (61,0%, adoptó posición vertical en el agua, en el período expulsivo (71,9%, y los recién nacidos recibieron Apgar al 5° minuto >7 (98,9%. La frecuencia de episiotomía fue 1,0%, 49,4% no necesitaron sutura perineal. Los resultados indican que el parto domiciliar es seguro.A cross-sectional study was performed to analyze obstetric and neonatal results of planned home births assisted by obstetric nurses in the city of Florianópolis, Southern Brazil. Data collected from the medical records of 100 parturient women cared for between 2005 and 2009 indicated 11 hospital transfers, nine of which underwent a Cesarean section. The majority of women who had a home birth showed normal fetal heart beat (94.0% and progress on the partogram (61.0%, vertical water delivery was the position most

  13. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia

    Directory of Open Access Journals (Sweden)

    Titaley Christiana R

    2010-08-01

    Full Text Available Abstract Background Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. Methods A qualitative study using focus group discussions (FGDs and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery. Results The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services. Conclusions A comprehensive strategy to increase the availability, accessibility, and

  14. Consequences for children of their birth planning status.

    Science.gov (United States)

    Baydar, N

    1995-01-01

    Of 1,327 children younger than two in 1986 whose mothers were participants in the National Longitudinal Survey of Youth, 61% were wanted, 34% were mistimed and 5% were unwanted. Planning status is associated with the level of developmental resources the child receives at home: At ages one and older, mistimed and unwanted children score significantly lower on a scale measuring opportunity for skill development and on a scale measuring nonauthoritarian parenting style than their wanted peers; by preschool age, they also have significantly less-positive relationships with their mothers. Measures of the direct effects of planning status on development also indicate that mistimed and unwanted children are at a disadvantage: Those younger than two have higher mean scores for fearfulness than wanted infants and lower scores for positive affect; unintended preschoolers score lower on a measure of receptive vocabulary.

  15. Crossing Borders in Birthing Practices: A Hmong Village in Northern Thailand (1987-2013

    Directory of Open Access Journals (Sweden)

    Kathleen A. Culhane-Pera

    2014-12-01

    Full Text Available Background: Over the past several decades in Northern Thailand, there has been a contest of authoritative knowledge between the Hmong traditional birth system and the Thai biomedical maternity system. In this paper, we explore the contest in one Hmong village by describing the traditional and biomedical practices; families’ birth location choices; and elements of authoritative knowledge. Methods: We built on a village survey and conducted an ethnographic qualitative case study of 16 families who made different pregnancy care choices. Results: The contest is being won by the Thai biomedical system, as most families deliver at the hospital. These families choose hospital births when they evaluate problems or potential problems; they have more confidence in the superior Thai biomedical system with its technology and medicines than in the inadequate Hmong traditional system. But the contest is ongoing, as some families prefer to birth at home. These families choose home births when they want a supportive home environment; they embrace traditional Hmong birth knowledge and practices as superior and reject hospital birth practices as unnecessary, harmful, abusive, and inadequate. Despite their choice for any given pregnancy, the case study families feel the pull of the other choice: hospital birth families lament loss of the home environment and express their dislike of hospital practices; and home birth families feel the anxiety of potentially needing quick obstetrical assistance that is far away. Conclusion: While most families choose to participate in the Thai biomedical system, they also use Hmong pregnancy and postpartum practices, and some families choose home births. In this village, the contest for the supremacy of authoritative birth knowledge is ongoing.

  16. "Home is always home" : (former) street youth in Blantyre, Malawi, and the fluidity of constructing home

    NARCIS (Netherlands)

    Hendriks, T.D.

    2016-01-01

    For many Malawians the concept of home is strongly associated with the rural areas and one's (supposedly rural) place of birth. This 'grand narrative about home', though often reiterated, doesn't necessarily depict lived reality. Malawi's history of movement and labor migration coupled with

  17. "Home is always home" : (former) street youth in Blantyre, Malawi, and the fluidity of constructing home

    NARCIS (Netherlands)

    Hendriks, T.D.

    2017-01-01

    For many Malawians the concept of home is strongly associated with the rural areas and one's (supposedly rural) place of birth. This 'grand narrative about home', though often reiterated, doesn't necessarily depict lived reality. Malawi's history of movement and labor migration coupled with

  18. CFSC (Community and Family Study Center) study finds birth rates falling everywhere - family planning (family planning) is a factor.

    Science.gov (United States)

    1978-08-01

    The findings of the Community and Family Study Center study, based on estimated crude birthrates and total fertility rates for 1968 and 1975, indicate that there has been a significant reduction in fertility levels of both developed and developing countries. Despite regional variations, the estimates show an average proportional decline of 8.5% in total fertility rates between 1968 and 1975. Of the 148 nations studied, 113 were in developing regions and 35 in the developed regions. Information on important social and economic development factors, such as life expectancy, literacy, percent of labor force in agriculture, per capita income, and family planning program strength were gathered for each country. Analyses of these data are reported in "The Public Interest" (to be published) "Population Reference Bulletin," October 1978, and a paper presented at the 1978 Population Association of America Meetings in Atlanta, Georgia. The recent change in fertility affected 81% of the world's population, primarily the peoples of Asia, Latin America, and North America. The total fertility rate in the world in 1968 was 4635 and declined to 4068 in 1975. More substantial declines occurred in Asia and Latin America, where the number of fewer births 1000 women would bear under a given fertility schedule declined by 845 births and 617 births, respectively. As more research is conducted to investigate the underlying causes of this decline, it is likely to confirm the important role that family planning programs have had in developing nations. Although major improvements in the socioeconomic well-being of the developing areas continue as an essential goal, the need to maintain the organized provision of family planning services should not be understated.

  19. Barriers to hospital births: why do many Bolivian women give birth at home?

    Directory of Open Access Journals (Sweden)

    Kelsey E. Otis

    2008-07-01

    Full Text Available OBJECTIVES: This study investigated the low rates of hospital/health center births recorded in Yapacaní, Bolivia, that persist despite the national maternal-infant insurance program designed to ensure equitable access to free center-based health care services for pregnant women. The purpose of this study was to identify the multilevel factors inhibiting access to and utilization of public health centers for labor and delivery. METHODS: Qualitative research methods were used, including participant observation, semistructured interviews of 62 community members, and key informant interviews with eight regional experts. Data were coded and analyzed using the grounded theory approach. RESULTS: From the semistructured interview data, five reasons for the low rate of institutional births and their frequency were identified: (1 fear or embarrassment related to receiving care at a public health care center (37%; (2 poor quality of care available at the health care centers (22%; (3 distance from or other geographic issues preventing timely travel to health care services (21%; (4 economic constraints preventing travel to or utilization of health care services (14%; and (5 the perception that health care services are not necessary due to the experience of "easy birth" (6%. CONCLUSIONS: The reasons for the low rate of births in public health centers exist within the context of deficient resources, politics, and cultural differences that all influence the experience of women and their partners at the time of birth. These large scale, contextual issues must be taken into account to improve access to quality health care services for all Bolivian women at the time of birth. Resources at the national level must be carefully targeted to ensure that governmental services will successfully instill confidence in Bolivian women and facilitate their overcoming the cultural, geographic, economic, and logistical barriers to accessing "free" services.

  20. MANAJEMEN SARANA PRASARANA DI DAY CARE BABY’S HOME SALATIGA

    Directory of Open Access Journals (Sweden)

    Desi Kusumawati

    2017-01-01

    Full Text Available Day Care is one form of early childhood education in non formal education program that organize nurturing and social welfare of children from birth up to the age of 6 years. This study aimed to identify the suitability of existing infrastructure in Baby's Home day care with the ACT of Minister of Education and Culture No. 137 of 2014 Article 32 Paragraph 3; and to provide an overview why the planning, maintenance and inventory in Baby's Home day care were not optimal. This study was qualitative research. The subject was Baby's Home day care Salatiga. Technique of collecting data using interviews, observation and documents. Data were analyzed using Miles and Huberman Model. Data validation using triangulation technique of data. Facilities and infrastructure in Baby's Home day care which conform with ACT of Minister of Education and Culture No. 137 of 2014 Article 32 Paragraph 3 of were the area of land, space of activities inside and outside, hand washing facilities, showers and latrines, and access to health facilities. While things were not conform included the bedroom, dining room, and covered trash. The cause of the planning, maintenance and inventory of facilities and infrastructure have not optimally done because the plan was not carried out continuously, the lack of personnel to assist in the maintenance, and did not have the administrative staff specifically for inventory. Advice can be given to Baby's Home day care is to conduct procurement planning infrastructure on sleeping room, dining room and trash. In addition, the maintenance to existing infrastructure must be made as well as the inventory of infrastructure in order to facilitate the planning purchasing.

  1. No fixed place of birth: unplanned BBAs in Victoria, Australia.

    Science.gov (United States)

    McLelland, Gayle; McKenna, Lisa; Archer, Frank

    2013-02-01

    the primary objective-to present data on the incidence of unplanned births before arrival (BBAs) in Victoria between 1991 and 2008. The secondary objective-to provide an extensive literature review highlighting the issues surrounding an unplanned BBA. the incidence of BBAs in Victoria published in the relevant government reports. data were extracted from published government reports pertaining to perinatal statistics in Victoria-The Australian Institute of Health and Wellbeing and the Perinatal Data Collection Unit of Victoria. Data on place of birth for each year from both sources was identified and tabulated. Comparisons between the data sources were undertaken to provide a picture of the scope of out of hospital birth. the incidence and absolute numbers of unplanned birth before arrival (BBA) to hospital in Victoria, are low compared to the total births. However, this number is comparable to unplanned BBAs in other developed countries with similar health systems. The incidence of unplanned BBAs has slowly but steadily doubled since 1991-2008. The two data sources almost mirror each other except for 1999 when there was an unexplained difference in the reported incidence in unplanned BBAs. Maternal and neonatal outcomes are disproportionally much poorer after unplanned BBAs than either planned home births or in hospital births. Various maternal factors can increase the risk of an unplanned BBA. multiple approaches should be adopted to manage unplanned BBAs. Antenatal screening should be undertaken to identify the women most at risk. Strategies can be developed that will reduce poor neonatal and maternal outcomes, including education for women and their partners on immediate management of the newborn; ensuring paramedics have current knowledge on care during childbirth; and maternity and ambulance services should develop management plans for care of women having unplanned BBAs. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. FastStats: Birth Defects or Congenital Anomalies

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Birth Defects or Congenital Anomalies Recommend on Facebook Tweet ... 4,825 Infant deaths per 100,000 live births: 121.3 Cause of infant death rank: 1 ...

  3. Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy.

    Science.gov (United States)

    Asztalos, Elizabeth V; Hannah, Mary E; Hutton, Eileen K; Willan, Andrew R; Allen, Alexander C; Armson, B Anthony; Gafni, Amiram; Joseph, K S; Ohlsson, Arne; Ross, Susan; Sanchez, J Johanna; Mangoff, Kathryn; Barrett, Jon F R

    2016-03-01

    The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Nursing home policies regarding advance care planning in Flanders, Belgium

    NARCIS (Netherlands)

    de Gendt, C.; Bilsen, J.; van der Stichele, R.; Deliens, L.

    2010-01-01

    Background: The aim of this study is to discover how many nursing homes (NHs) in Flanders (Belgium) have policies on advance care planning (ACP) and their content regarding different medical end-of-life decisions. Methods: A structured mail questionnaire was sent to the NH administrators of all 594

  5. Giving birth, going home: influences on when low-income women leave hospital.

    Science.gov (United States)

    Lichtenstein, Bronwen; Brumfield, Cynthia; Cliver, Suzanne; Chapman, Victoria; Lenze, Deanna; Davis, Valisia

    2004-01-01

    The US Newborns' and Mothers' Health Protection Act of 1996 ('The Two-Day Law') mandates insurance coverage for women who have just given birth to remain in hospital for two days post-partum. However, many women are being discharged from hospital after 24 hours. To assess why early discharge is still occurring, a study of 406 new mothers was conducted at an urban metropolitan hospital in the USA. The women were aware of the new law (95%) but decision making was often relinquished to hospital authorities. Patients who stayed longer tended to be more assertive in decision making, and used the Two-Day Law as leverage in discussions about going home. The study concluded that the nurses were authoritative and often influential agents in the decision-making process, and that patients were likely to interpret specific interactions with hospital staff as a signal to leave.

  6. Patterns of birth weight at a community level

    African Journals Online (AJOL)

    user

    identified a one-year live birth cohort of 8,273 in Jimma, Illubabor and Keffa ... METHODS: This was a community-based longitudinal study, which attempts to ... RESULTS: The results of the study found an estimated low birth weight rate ... mothers' experience of previous child deaths. ... births occur at home. ..... assessment.

  7. Accuracy of maternal recall of birth weight and selected delivery ...

    African Journals Online (AJOL)

    Those who delivered at home (15%) were either assisted by a relative or Traditional Birth Attendant (TBA). Over three quarters (78.5%) of the mothers had birth weights of their children recorded in the postnatal care cards. Out of 38 children who were born at home, 87% (n = 33) were not weighed and there were 23 women ...

  8. Family participation in care plan meetings : Promoting a collaborative organizational culture in nursing homes

    NARCIS (Netherlands)

    Dijkstra, Ate

    In this study, the author evaluated a project in The Netherlands that aimed to promote family members' participation in care plan meetings at a psychogeriatric nursing home. The small-scale pilot project, which was conducted in four wards of the nursing home, was designed to involve families in

  9. Vaginal birth after cesarean: neonatal outcomes and United States birth setting.

    Science.gov (United States)

    Tilden, Ellen L; Cheyney, Melissa; Guise, Jeanne-Marie; Emeis, Cathy; Lapidus, Jodi; Biel, Frances M; Wiedrick, Jack; Snowden, Jonathan M

    2017-04-01

    Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score birthing their second child by vaginal birth after cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible

  10. Local adaptations to a global health initiative: penalties for home births in Zambia.

    Science.gov (United States)

    Greeson, Dana; Sacks, Emma; Masvawure, Tsitsi B; Austin-Evelyn, Katherine; Kruk, Margaret E; Macwan'gi, Mubiana; Grépin, Karen A

    2016-11-01

    Global health initiatives (GHIs) are implemented across a variety of geographies and cultures. Those targeting maternal health often prioritise increasing facility delivery rates. Pressure on local implementers to meet GHI goals may lead to unintended programme features that could negatively impact women. This study investigates penalties for home births imposed by traditional leaders on women during the implementation of Saving Mothers, Giving Life (SMGL) in Zambia. Forty focus group discussions (FGDs) were conducted across four rural districts to assess community experiences of SMGL at the conclusion of its first year. Participants included women who recently delivered at home (3 FGDs/district), women who recently delivered in a health facility (3 FGDs/district), community health workers (2 FGDs/district) and local leaders (2 FGDs/district). Findings indicate that community leaders in some districts-independently of formal programme directive-used fines to penalise women who delivered at home rather than in a facility. Participants in nearly all focus groups reported hearing about the imposition of penalties following programme implementation. Some women reported experiencing penalties firsthand, including cash and livestock fines, or fees for child health cards that are typically free. Many women who delivered at home reported their intention to deliver in a facility in the future to avoid penalties. While communities largely supported the use of penalties to promote facility delivery, the penalties effectively introduced a new tax on poor rural women and may have deterred their utilization of postnatal and child health care services. The imposition of penalties is thus a punitive adaptation that can impose new financial burdens on vulnerable women and contribute to widening health, economic and gender inequities in communities. Health initiatives that aim to increase demand for health services should monitor local efforts to achieve programme targets in order

  11. Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.

    Science.gov (United States)

    Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W George

    2018-03-01

    In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

  12. The HOME Inventory and Family Demographics.

    Science.gov (United States)

    Bradley, Robert H.; Caldwell, Bettye M.

    1984-01-01

    Examines the relation between the Home Observation for Measurement of Environment (HOME) Inventory and sex, race, socioeconomic status, the amount of crowding in the home, and birth order. Performs multivariate analysis of covariance on an intact family sample using HOME subscales as criterion measures and status and structural variables as…

  13. Patient satisfaction with home-birth care in The Netherlands.

    NARCIS (Netherlands)

    Kerssens, J.J.

    1994-01-01

    One of the necessary elements in an obstetric system of home confinements is well-organized postnatal home care. In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry

  14. Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study.

    Science.gov (United States)

    Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

    2018-04-13

    Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

  15. Traditional Birth Attendants Issue: A Menace in Developing Countries

    African Journals Online (AJOL)

    BACKGROUND: A significant proportion of births in Nigeria still occur at homes of traditional birth attendant. Traditional birth attendants are popular in developing and low resource countries. They lack no formal education or medical training and their clients end up with obstetric complications which lead to severe morbidity ...

  16. Barriers to Skilled Birth Attendance: A Survey among Mothers in ...

    African Journals Online (AJOL)

    More than seventy percent of the participants gave birth attended by a traditional birth attendant, but only 27% had intended to give birth at home. Sixty-four percent had made advance arrangements for the childbirth. Only 22% were informed about expected time of birth during antenatal care. Our findings suggest that the ...

  17. Development and validation of a national data registry for midwife-led births: the Midwives Alliance of North America Statistics Project 2.0 dataset.

    Science.gov (United States)

    Cheyney, Melissa; Bovbjerg, Marit; Everson, Courtney; Gordon, Wendy; Hannibal, Darcy; Vedam, Saraswathi

    2014-01-01

    In 2004, the Midwives Alliance of North America's (MANA's) Division of Research developed a Web-based data collection system to gather information on the practices and outcomes associated with midwife-led births in the United States. This system, called the MANA Statistics Project (MANA Stats), grew out of a widely acknowledged need for more reliable data on outcomes by intended place of birth. This article describes the history and development of the MANA Stats birth registry and provides an analysis of the 2.0 dataset's content, strengths, and limitations. Data collection and review procedures for the MANA Stats 2.0 dataset are described, along with methods for the assessment of data accuracy. We calculated descriptive statistics for client demographics and contributing midwife credentials, and assessed the quality of data by calculating point estimates, 95% confidence intervals, and kappa statistics for key outcomes on pre- and postreview samples of records. The MANA Stats 2.0 dataset (2004-2009) contains 24,848 courses of care, 20,893 of which are for women who planned a home or birth center birth at the onset of labor. The majority of these records were planned home births (81%). Births were attended primarily by certified professional midwives (73%), and clients were largely white (92%), married (87%), and college-educated (49%). Data quality analyses of 9932 records revealed no differences between pre- and postreviewed samples for 7 key benchmarking variables (kappa, 0.98-1.00). The MANA Stats 2.0 data were accurately entered by participants; any errors in this dataset are likely random and not systematic. The primary limitation of the 2.0 dataset is that the sample was captured through voluntary participation; thus, it may not accurately reflect population-based outcomes. The dataset's primary strength is that it will allow for the examination of research questions on normal physiologic birth and midwife-led birth outcomes by intended place of birth.

  18. Antenatal Care and Skilled Birth Attendance in Three Communities ...

    African Journals Online (AJOL)

    Antenatal Care and Skilled Birth Attendance in Three Communities in Kaduna State, Nigeria. ... Most importantly, safer delivery options that would be acceptable in communities where women traditionally birth at home need to be explored (Afr. J. Reprod. Health 2010; 14[3]: 89-96). Key words: Antenatal care, skilled birth ...

  19. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention.

    Science.gov (United States)

    Magoma, Moke; Requejo, Jennifer; Campbell, Oona M R; Cousens, Simon; Filippi, Veronique

    2010-03-19

    In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated. Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed. The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis. Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of

  20. Persistent mission home delivery in ibadan: attractive role of traditional birth attendants.

    Science.gov (United States)

    Ayede, A I

    2012-12-01

    One of the major factors responsible for high maternal and neonatal deaths in Nigeria and other developing countries is the use of Traditional Birth Attendants (TBAs). The current study was carried out to evaluate the attractive roles of the TBAs that make pregnant mothers persistently use them. The study was conducted in Ido and Lagelu local government areas of Oyo State in Nigeria. TBA basic demographic data were collected and were then followed up for a period of six months by trained Nurses and Doctors targeting a total of ten direct observations made per TBA per ANC/delivery. There were a total of 146 TBAs out of which 134 fulfilled the inclusion criteria and were recruited into the study. The Male to female ratio was 1/133 and age range was 22-68 years with 70.1 % above 40 years. Seventy two per cent of them had only elementary school and 72%, 30% and 38% had been re-trained by LGA, SMOH and National TBA associations respectively. Post- partum care, counseling services, tender care in labour, easy accessibility, accommodating other relations, installmental payment were observed in all TBAs while 60-98% of them did home visit, assisted in referral and arranged for USS and laboratory services. These good practices should be incorporated into formal health sector and attitudinal change in the current health workers across all health care levels should be encouraged. CHEWs should also be primarily involved in home visit in pregnancy and post-natal care services.

  1. Changing trends on the place of delivery: why do Nepali women give birth at home?

    Directory of Open Access Journals (Sweden)

    Shrestha Saraswoti

    2012-10-01

    Full Text Available Abstract Background Home delivery in unhygienic environment is common in Nepal. This study aimed to identify whether practice of delivery is changing over time and to explore the factors contributing to women’s decision for choice of place of delivery. Methods A community based cross sectional study was conducted among 732 married women of reproductive age (MWRA in Kavrepalanchok district of Nepal in 2011. Study wards were selected randomly and all MWRA residing in the selected wards were interviewed. Data were collected through pre-tested interviewer administered questionnaire. Chi-square and multivariate analysis was used to examine the association between socio-demographic factors and place of delivery. Results The study shows that there was almost 50% increasement in institutional delivery over the past ten years. The percentage of last birth delivered in health institution has increased from 33.7% before 10 years to 63.8% in the past 5 years. However, the place of delivery varied according to residence. In urban area, most women 72.3% delivered in health institutions while only 35% women in rural and 17.5% in remote parts delivered in health institutions. The key socio-demographic factors influencing choice of place of delivery included multi parity, teen-age pregnancy, less or no antenatal visits. Having a distant health center, difficult geographical terrain, lack of transportation, financial constraints and dominance of the mothers- in-law were the other main reasons for choosing a home delivery. Psychological vulnerability and insecurity of rural women also led to home delivery, as women were shy and embarrassed in visiting the health center. Conclusion The trend of delivery at health institution was remarkably increased but there were strong differentials in urban–rural residency and low social status of women. Shyness, dominance of mothers in law and ignorance was one of the main reasons contributing to home delivery.

  2. Becoming a parent to a child with birth asphyxia—From a traumatic delivery to living with the experience at home

    Directory of Open Access Journals (Sweden)

    Alina Heringhaus

    2013-04-01

    Full Text Available The aim of this study is to describe the experiences of becoming a parent to a child with birth asphyxia treated with hypothermia in the neonatal intensive care unit (NICU. In line with the medical advances, the survival of critically ill infants with increased risk of morbidity is increasing. Children who survive birth asphyxia are at a higher risk of functional impairments, cerebral palsy (CP, or impaired vision and hearing. Since 2006, hypothermia treatment following birth asphyxia is used in many of the Swedish neonatal units to reduce the risk of brain injury. To date, research on the experience of parenthood of the child with birth asphyxia is sparse. To improve today's neonatal care delivery, health-care providers need to better understand the experiences of becoming a parent to a child with birth asphyxia. A total of 26 parents of 16 children with birth asphyxia treated with hypothermia in a Swedish NICU were interviewed. The transcribed interview texts were analysed according to a qualitative latent content analysis. We found that the experience of becoming a parent to a child with birth asphyxia treated with hypothermia at the NICU was a strenuous journey of overriding an emotional rollercoaster, that is, from being thrown into a chaotic situation which started with a traumatic delivery to later processing the difficult situation of believing the child might not survive or was to be seriously affected by the asphyxia. The prolonged parent–infant separation due to the hypothermia treatment and parents’ fear of touching the infant because of the high-tech equipment seemed to hamper the parent–infant bonding. The adaption of the everyday life at home seemed to be facilitated by the follow-up information of the doctor after discharge. The results of this study underline the importance of family-centered support during and also after the NICU discharge.

  3. Becoming a parent to a child with birth asphyxia-From a traumatic delivery to living with the experience at home.

    Science.gov (United States)

    Heringhaus, Alina; Blom, Michaela Dellenmark; Wigert, Helena

    2013-04-30

    The aim of this study is to describe the experiences of becoming a parent to a child with birth asphyxia treated with hypothermia in the neonatal intensive care unit (NICU). In line with the medical advances, the survival of critically ill infants with increased risk of morbidity is increasing. Children who survive birth asphyxia are at a higher risk of functional impairments, cerebral palsy (CP), or impaired vision and hearing. Since 2006, hypothermia treatment following birth asphyxia is used in many of the Swedish neonatal units to reduce the risk of brain injury. To date, research on the experience of parenthood of the child with birth asphyxia is sparse. To improve today's neonatal care delivery, health-care providers need to better understand the experiences of becoming a parent to a child with birth asphyxia. A total of 26 parents of 16 children with birth asphyxia treated with hypothermia in a Swedish NICU were interviewed. The transcribed interview texts were analysed according to a qualitative latent content analysis. We found that the experience of becoming a parent to a child with birth asphyxia treated with hypothermia at the NICU was a strenuous journey of overriding an emotional rollercoaster, that is, from being thrown into a chaotic situation which started with a traumatic delivery to later processing the difficult situation of believing the child might not survive or was to be seriously affected by the asphyxia. The prolonged parent-infant separation due to the hypothermia treatment and parents' fear of touching the infant because of the high-tech equipment seemed to hamper the parent-infant bonding. The adaption of the everyday life at home seemed to be facilitated by the follow-up information of the doctor after discharge. The results of this study underline the importance of family-centered support during and also after the NICU discharge.

  4. Outcomes and risk factors for unplanned delivery at home and before arrival to the hospital.

    Science.gov (United States)

    Lazić, Zlatko; Takač, Iztok

    2011-01-01

    The aim of this study was to analyze the outcomes and risk factors for unplanned delivery at home and before arrival to the hospital in Maribor region, Slovenia. We used data from medical records of all deliveries in Maribor region from the year 1997 to the year 2005. We analysed a total of 17,846 births from annual reports of the Maribor University Hospital. Among the total of 17,846 births, there were 58 (3.2‰) unplanned births at home and on the way to the hospital. The study based on the data from medical records on safety of unplanned home birth reveals that hospital delivery is approximately 7 times safer than unplanned home delivery. This conclusion is reached by comparing perinatal mortality, which was 68‰ for unplanned deliveries at home versus 8.8‰ for deliveries at hospital. The prematurity was more common in unplanned home deliveries: 13 (22%) versus 1399 (8%) for hospital deliveries. Unplanned deliveries at home and on the way to the hospital were more common in multiparous women (ratio 4:1 compared to 1:1 for hospital births). When for all hospital deliveries the pregnancies were followed, for one third of unplanned deliveries at home or on the way to the hospital the pregnancies were not monitored. Mothers who gave birth at home or on the way to the hospital were without higher education (i.e. 55.2%) and mothers who gave birth in hospital were with higher education (i.e. 87.4%). There was higher rate of perinatal morbidity for unplanned home deliveries compared to hospital deliveries. Factors that make unplanned home deliveries more common are high parity, absence or inadequacy of antenatal care, marital status and lower education. Some conditions in newborn, such as hypothermia, were clearly the result of unplanned birth at home. Additional effort to improve antenatal care and also identifying social vulnerabilities would possibly decrease the number of unplanned deliveries and improve the perinatal outcomes.

  5. Understanding Pregnancy and Birth Issues

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Understanding Pregnancy and Birth Issues Past Issues / Winter 2008 Table ... turn Javascript on. What is a High-Risk Pregnancy? All pregnancies involve a certain degree of risk ...

  6. Reasons for and challenges of recent increases in teen birth rates: a study of family planning service policies and demographic changes at the state level.

    Science.gov (United States)

    Yang, Zhou; Gaydos, Laura M

    2010-06-01

    After declining for over a decade, the birth rate in the United States for adolescents aged 15-19 years increased by 3% in 2006 and 1% again in 2007. We examined demographic and policy reasons for this trend at state level. With data merged from multiple sources, descriptive analysis was used to detect state-level trends in birth rate and policy changes from 2000 to 2006, and variations in the distribution of teen birth rates, sex education, and family planning service policies, and demographic features across each state in 2006. Regression analysis was then conducted to estimate the effect of several reproductive health policies and demographic features on teen birth rates at the state level. Instrument variable was used to correct possible bias in the regression analysis. Medicaid family planning waivers were found to reduce teen birth rates across all ages and races. Abstinence-only education programs were found to cause an increase in teen birth rates among white and black teens. The increasing Hispanic population is another driving force for high teen birth rates. Both demographic factors and policy changes contributed to the increase in teen birth rates between 2000 and 2006. Future policy and behavioral interventions should focus on promoting and increasing access to contraceptive use. Family planning policies should be crafted to address the special needs of teens from different cultural backgrounds, especially Hispanics. Copyright 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  7. Effects of Birth Order and Spacing on Mother-Infant Interactions.

    Science.gov (United States)

    Lewis, Michael; Kreitzberg, Valerie S.

    1979-01-01

    Examines early differences in mother-infant interaction as a function of infant birth order and birth spacing. Mother and infant behaviors were observed and recorded in the home for a two-hour period. (SS)

  8. Career plans of primary care midwives in the Netherlands and their intentions to leave the current job.

    NARCIS (Netherlands)

    Warmelink, J.C.; Wiegers, T.A.; Cock, T.P. de; Spelten, E.R.; Hutton, E.K.

    2015-01-01

    Background: In labour market policy and planning, it is important to understand the motivations of people to continue in their current job or to seek other employment. Over the last decade, besides the increasingly medical approach to pregnancy and childbirth and decreasing home births, there were

  9. DOE Zero Energy Ready Home Case Study: Thrive Home Builders, Lowry Plan

    Energy Technology Data Exchange (ETDEWEB)

    Pacific Northwest National Laboratory

    2017-09-01

    Thrive Home Builders built this 4,119-ft2 home at the Lowry development in Denver, Colorado, to the high-performance criteria of the U.S. Department of Energy’s Zero Energy Ready Home Program. Despite the dense positioning of the homes, mono-plane roof designs afforded plenty of space for the 8.68 kW of photovoltaic panels. With the PV, the home achieves a Home Energy Rating System (HERS) score of 4 and the home owners should enjoy energy bills of about $-11 a year. Without the PV, the home would score a HERS 38 (far lower than the HERS 80 to 100 of typical new homes).

  10. Inadequate birth spacing is perceived as riskier than all family planning methods, except sterilization and abortion, in a qualitative study among urban Nigerians.

    Science.gov (United States)

    Schwandt, Hilary M; Skinner, Joanna; Hebert, Luciana Estelle; Cobb, Lisa; Saad, Abdulmumin; Odeku, Mojisola

    2017-09-11

    Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians. A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach. The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items. Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing. This study is not a randomized control trial so the study has not been registered as such.

  11. Birth control and family planning

    Science.gov (United States)

    ... of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Birth Control Read more NIH MedlinePlus Magazine Read more Health ...

  12. [Live birth distribution by time and place from 1981 to 1998 in Japan].

    Science.gov (United States)

    Matsushima, Noriko; Morita, Noriko; Ogata, Nozomi; Saeki, Keigo; Matsuda, Ryozo; Kurumatani, Norio

    2003-01-01

    To investigate the diurnal rhythm of live births labored spontaneously, and the effects of obstetric intervention on birth time distributions. The data of live births tabulated by time (one-hour intervals), date and birthplace throughout Japan between 1981 and 1998 were obtained with permission from the former Ministry of Health and Welfare. Together with an investigation of hourly birth numbers by place in each year, an annual transition of hourly birth rates in medical institutions and the diurnal rhythm of birth numbers in maternity homes and at home were analyzed using regression analysis. In every calendar year studied the hourly live birth numbers at hospitals showed a single-peak distribution pattern with maximum values at 13:00-15:00. The annual transition of hourly birth rates showed a 10% (birth numbers base) decrease in the 11:00-13:00 period in 1998 as compared with that in 1981, while there was a corresponding increase of 8% in the 13:00-15:00 period. Hourly birth numbers at clinics showed a double-peak distribution pattern with maximum values during the 11:00-12:00 and 14:00-15:00 periods in early 1980, while a single-peak distribution with a maximum value during the 13:00-15:00 period appeared in 1989 and has remained thereafter. Hourly birth rates (birth numbers base) increased by over 6% in the 13:00-15:00 and 17:00-20:00 periods over the past 18 years, while they decreased by 10% in the 9:00-13:00 period. The results at maternity homes were clearly different from those at hospitals and clinics. The live birth numbers totaled for the 18 years showed a double-phase distribution with a maximum value in the 6:00-7:00 period and a minimum value in the 19:00-20:00 period. The best-fit regression model for the obtained data was a sine curve with a maximum value at 6:00 (coefficient of determination 0.97). Hourly distributions of live births at home also fitted best to a since curve with the maximum value again at 6:00 (coefficient of determination 0

  13. Prevalence and determinants of low birth weight: the situation in a ...

    African Journals Online (AJOL)

    Background: The traditional birth attendant delivers majority of pregnant women in Nigeria. Objective: This study aimed at determining the prevalence and associated risk factors for delivery of low birth weight (LBW) neonates in a Traditional Birth Home (TBH)in Benin City, Nigeria. Methods: A total of 780 pregnant women ...

  14. Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh.

    Science.gov (United States)

    Ahmed, Salahuddin; Norton, Maureen; Williams, Emma; Ahmed, Saifuddin; Shah, Rasheduzzaman; Begum, Nazma; Mungia, Jaime; Lefevre, Amnesty; Al-Kabir, Ahmed; Winch, Peter J; McKaig, Catharine; Baqui, Abdullah H

    2013-08-01

    Short birth intervals are associated with increased risk of adverse maternal and neonatal health (MNH) outcomes. Improving postpartum contraceptive use is an important programmatic strategy to improve the health and well-being of women, newborns, and children. This article documents the intervention package and evaluation design of a study conducted in a rural district of Bangladesh to evaluate the effects of an integrated, community-based MNH and postpartum family planning program on contraceptive use and birth-interval lengths. The study integrated family planning counseling within 5 community health worker (CHW)-household visits to pregnant and postpartum women, while a community mobilizer (CM) led community meetings on the importance of postpartum family planning and pregnancy spacing for maternal and child health. The CM and the CHWs emphasized 3 messages: (1) Use of the Lactational Amenorrhea Method (LAM) during the first 6 months postpartum and transition to another modern contraceptive method; (2) Exclusive, rather than fully or nearly fully, breastfeeding to support LAM effectiveness and good infant breastfeeding practices; (3) Use of a modern contraceptive method after a live birth for at least 24 months before attempting another pregnancy (a birth-to-birth interval of about 3 years) to support improved infant health and nutrition. CHWs provided only family planning counseling in the original study design, but we later added community-based distribution of methods, and referrals for clinical methods, to meet women's demand. Using a quasi-experimental design, and relying primarily on pre/post-household surveys, we selected pregnant women from 4 unions to receive the intervention (n = 2,280) and pregnant women from 4 other unions (n = 2,290) to serve as the comparison group. Enrollment occurred between 2007 and 2009, and data collection ended in January 2013. Formative research showed that women and their family members generally did not perceive

  15. Mode of birth in twins: data and reflections.

    Science.gov (United States)

    Reitter, A; Daviss, B A; Krimphove, M J; Johnson, K C; Schlößer, R; Louwen, F; Bisits, A

    2018-02-12

    Our primary objective was to compare neonatal and maternal outcomes in women with twin pregnancies, beyond 32 weeks, having a planned vaginal birth or a planned caesarean section (CS). This was a retrospective cohort study from a single tertiary centre over nine years. 534 sets of twins ≥32 + 0 weeks of gestation were included. 401 sets were planned vaginally and 133 sets were planned by CS. We compared a composite adverse perinatal outcome (perinatal mortality or serious neonatal morbidity; five minute APGAR score ≤4, neurological abnormality and need for intubation) and a composite maternal adverse outcome (major haemorrhage, trauma or infection) between the groups. There were no significant differences. Given the similarity of these results with several other larger studies of twin birth, we sought to look at reasons why there is still a rising rate of CS for twin births. We further make suggestions for keeping this rate to a sensible minimum. Impact statement What is already known on this subject? The largest randomised controlled study comparing planned vaginal birth with planned CSs for lower risk twins between 32 and 39 weeks of gestation, showed no added safety from planned CS. However, in most of the Western countries this conclusion has failed to increase the number of planned vaginal births for lower risk twins. What do the results of this study add? This observational study from a single tertiary centre provides external validation of the twin trial results in a practical day-to-day setting. It also provides insights as to how planned vaginal birth can be developed and maintained, with a key focus on safety and maternal participation in decision making. It does focus on consent and providing accurate data. What are the implications of these findings for clinical practice and/or further research? There are good grounds to encourage vaginal birth for low-risk twin pregnancies. The trend of rising caesarean rates in low-risk twin

  16. Location Planning Problem of Service Centers for Sustainable Home Healthcare: Evidence from the Empirical Analysis of Shanghai

    Directory of Open Access Journals (Sweden)

    Gang Du

    2015-11-01

    Full Text Available It is of theoretical and practical significance to understand what factors influence the sustainable development of home healthcare services in China. Based on a face-to-face survey, we find that the location planning, which is decisive for the improvement of patient satisfaction, can effectively reduce the risks, as well as the costs of redundant construction and re-construction of service centers for home healthcare and, thus, helps ensure the sustainability of health and the environment. The purposes of this paper are to investigate the existing problem of home healthcare in Shanghai and to find the optimum location planning scheme under several realistic constraints. By considering differentiated services provided by the medical staff at different levels and the degrees of patient satisfaction, a mixed integer programming model is built to minimize the total medical cost. The IBM ILOGCPLEX is used to solve the above model. Finally, a case study of Putuo district in Shanghai is conducted to validate the proposed model and methodology. Results indicate that the model used in this paper can effectively reduce the total medical cost and enhance the medical sustainability, and therefore, the results of the model can be used as a reference for decision makers on the location planning problem of home healthcare services in China.

  17. Applying Utility Functions to Adaptation Planning for Home Automation Applications

    Science.gov (United States)

    Bratskas, Pyrros; Paspallis, Nearchos; Kakousis, Konstantinos; Papadopoulos, George A.

    A pervasive computing environment typically comprises multiple embedded devices that may interact together and with mobile users. These users are part of the environment, and they experience it through a variety of devices embedded in the environment. This perception involves technologies which may be heterogeneous, pervasive, and dynamic. Due to the highly dynamic properties of such environments, the software systems running on them have to face problems such as user mobility, service failures, or resource and goal changes which may happen in an unpredictable manner. To cope with these problems, such systems must be autonomous and self-managed. In this chapter we deal with a special kind of a ubiquitous environment, a smart home environment, and introduce a user-preference-based model for adaptation planning. The model, which dynamically forms a set of configuration plans for resources, reasons automatically and autonomously, based on utility functions, on which plan is likely to best achieve the user's goals with respect to resource availability and user needs.

  18. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention

    Directory of Open Access Journals (Sweden)

    Cousens Simon

    2010-03-01

    Full Text Available Abstract Background In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated. Methods Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed. Results The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis. Conclusions Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care

  19. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Sapra, Katherine J; Brent, Robert L; Levene, Malcolm I; Arabin, Birgit; Chervenak, Frank A

    2013-10-01

    To examine the occurrence of 5-minute Apgar scores of 0 and seizures or serious neurologic dysfunction for 4 groups by birth setting and birth attendant (hospital physician, hospital midwife, free-standing birth center midwife, and home midwife) in the United States from 2007-2010. Data from the United States Centers for Disease Control's National Center for Health Statistics birth certificate data files were used to assess deliveries by physicians and midwives in and out of the hospital for the 4-year period from 2007-2010 for singleton term births (≥37 weeks' gestation) and ≥2500 g. Five-minute Apgar scores of 0 and neonatal seizures or serious neurologic dysfunction were analyzed for 4 groups by birth setting and birth attendant (hospital physician, hospital midwife, freestanding birth center midwife, and home midwife). Home births (relative risk [RR], 10.55) and births in free-standing birth centers (RR, 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of 0 (P births attended by physicians or midwives. Home births (RR, 3.80) and births in freestanding birth centers attended by midwives (RR, 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (P births attended by physicians or midwives. The increased risk of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunction of out-of-hospital births should be disclosed by obstetric practitioners to women who express an interest in out-of-hospital birth. Physicians should address patients' motivations for out-of-hospital delivery by continuously improving safe and compassionate care of pregnant, fetal, and neonatal patients in the hospital setting. Copyright © 2013 Mosby, Inc. All rights reserved.

  20. The Danish Medical Birth Register

    DEFF Research Database (Denmark)

    Bliddal, Mette; Broe, Anne; Pottegård, Anton

    2018-01-01

    The Danish Medical Birth Register was established in 1973. It is a key component of the Danish health information system. The register enables monitoring of the health of pregnant women and their offspring, it provides data for quality assessment of the perinatal care in Denmark, and it is used...... on all births in Denmark and comprises primarily of data from the Danish National Patient Registry supplemented with forms on home deliveries and stillbirths. It contains information on maternal age provided by the Civil Registration System. Information on pre-pregnancy body mass index and smoking...

  1. Barrier Methods of Birth Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap

    Science.gov (United States)

    ... ACOG Barrier Methods of Birth Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap Home For Patients Search ... Format Barrier Methods of Birth Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap Contraception What are barrier ...

  2. Correlates of preferences for home or hospital confinement in Pakistan: evidence from a national survey.

    Science.gov (United States)

    Javed, Sajid Amin; Anjum, Muhammad Danish; Imran, Waqas; Haider, Azad; Shiraz, Ayesha; Shaheen, Farzana; Iftikhar ul Husnain, Muhammad

    2013-06-24

    Despite the pregnancy complications related to home births, homes remain yet major place of delivery in Pakistan and 65 percent of totals births take place at home. This work analyses the determinants of place of delivery in Pakistan. Multivariate Logistic regression is used for analysis. Data are extracted from Pakistan Demographic and Health Survey (2006-07). Based on information on last birth preceding 5 years of survey, we construct dichotomous dependent variable i.e. whether women deliver at home (Coded=1) or at health facility (coded=2). Bivariate analysis shows that 72% (p≤0.000) women from rural area and 81% women residing in Baluchistan delivered babies at home. Furthermore 75% women with no formal education, 81% (p≤0.000) women working in agricultural sector, 75% (p≤0.000) of Women who have 5 and more children and almost 77% (p≤0.000) who do not discussed pregnancy related issues with their husbands are found delivering babies at home. Multivariate analysis documents that mothers having lower levels of education, economic status and empowerment, belonging to rural area, residing in provinces other than Punjab, working in agriculture sector and mothers who are young are more likely to give births at home. A trend for home births, among Pakistani women, can be traced in lower levels of education, lower autonomy, poverty driven working in agriculture sector, higher costs of using health facilities and regional backwardness.

  3. [Journalism and family planning in Guinea-Bissau. Putting the accent on birth spacing].

    Science.gov (United States)

    Vaz, C

    1989-05-01

    A conference on awareness in the mass media of the problems of family planning was held in March 1989 at Bissau by the Guinean Association for Education and Promotion of Family Health (AGEPSF). Representatives of radio, a daily newspaper, and the national press agency discussed the objectives of AGEPSF and the benefits of family planning with specialists in different sectors of national life. The secretary general of AGEPSF affirmed the interest of the government in creating a health organization to coordinate national policy in family planning and to diffuse information on family planning. The family planning objective of the AGEPSF is not limitation of births but rather spacing to promote maternal and child health. AGEPSF is a member of the International Planned Parenthood Federation and maintains relations with similar organizations throughout the world. According to the director of the national maternity hospital, family planning is a sensitive topic but it has become accepted in numerous countries as marriage in rural areas and abortions in urban areas are widespread practices in Africa with potentially grave consequences. The general director of the National Institute for Studies and Research placed the theme of family planning in the context of Guinea-Bissau by citing the low level of education, the almost insignificant number of literate women, and the lack of health services in rural areas as the principal causes of increasing infant mortality in the country. African countries should create favorable conditions, elevate the level of living of their populations, and develop concrete health actions to reduce infant and maternal mortality.

  4. 26 CFR 54.9811-1 - Standards relating to benefits for mothers and newborns.

    Science.gov (United States)

    2010-04-01

    ... covered under a group health plan gives birth at home by vaginal delivery. After the delivery, the woman.... A woman covered under a group health plan gives birth by vaginal delivery at home. The child later... births, at the time of the last delivery). (ii) Delivery outside a hospital. If delivery occurs outside a...

  5. DOE Zero Energy Ready Home Case Study: New Town Builders — The ArtiZEN Plan, Denver, CO

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2014-09-01

    The Grand Winner in the Production Builder category of the 2014 Housing Innovation Awards, this builder plans to convert all of its product lines to DOE Zero Energy Ready Home construction by the end of 2015. This home achieves HERS 38 without photovoltaics (PV) and HERS -3 with 8.0 kW of PV.

  6. Institutional racism, neighborhood factors, stress, and preterm birth.

    Science.gov (United States)

    Mendez, Dara D; Hogan, Vijaya K; Culhane, Jennifer F

    2014-01-01

    Racial/ethnic disparities in the risk of preterm birth may be explained by various factors, and previous studies are limited in examining the role of institutional racism. This study focused on the following questions: what is the association between preterm birth and institutional racism as measured by residential racial segregation (geographic separation by race) and redlining (black-white disparity in mortgage loan denial); and what is the association between preterm birth and reported stress, discrimination, and neighborhood quality. We used data from a clinic-based sample of pregnant women (n = 3462) participating in a stress and pregnancy study conducted from 1999 to 2004 in Philadelphia, PA (USA). We linked data from the 2000 US Census and Home Mortgage Disclosure Act (HMDA) data from 1999 to 2004 and developed measures of residential redlining and segregation. Among the entire population, there was an increased risk for preterm birth among women who were older, unmarried, tobacco users, higher number of previous births, high levels of experiences of everyday discrimination, owned their homes, lived in nonredlined areas, and areas with high levels of segregation measured by the isolation index. Among black women, living in a redlined area (where blacks were more likely to be denied mortgage loans compared to whites) was moderately associated with a decreased risk of preterm birth (aRR = 0.8, 95% CI: 0.6, 0.99). Residential redlining as a form institutional racism and neighborhood characteristic may be important for understanding racial/ethnic disparities in pregnancy and preterm birth.

  7. ROLES OF TRADITIONAL BIRTH ATTENDANTS AND PERCEPTIONS ON THE POLICY DISCOURAGING HOME DELIVERY IN COASTAL KENYA.

    Science.gov (United States)

    Wanyua, S; Kaneko, S; Karama, M; Makokha, A; Ndemwa, M; Kisule, A; Changoma, M; Goto, K; Shimada, M

    2014-03-01

    To describe the roles of Traditional Birth Attendants (TBAs), to determine the perceptions of TBAs and Skilled Birth Attendants (SBAs) towards the policy discouraging home delivery by TBAs and to establish the working relationship between TBAs and SBAs in Kwale, Kenya. Community based cross-sectional study. Mwaluphamba, Kinango and Golini locations of Kwale County, Kenya. Fifty eight participants were involved in the study. Interviews were conducted with 22 TBAs and 8 SBAs as well as 3 FGDs with 28 TBAs were carried out in July 2012. Roles of TBAs, policy awareness and support as well as the working relationship between TBAs and SBAs. Before delivery, the main role of TBAs was checking position of the baby in the womb (86%) while during delivery, the main role was stomach massage (64%). However, majority (95%) of the TBAs did not provide any after delivery. All SBAs and 59% of TBAs were aware of the policy while 88% SBAs and 36% of TBAs supported it. The working relationship between TBAs and SBAs mainly involved the referral of women to health facilities (HFs). Sometimes, TBAs accompanied women to the HF offering emotional support until after delivery. TBAs in Kwale have a big role to play especially during pregnancy and delivery periods. Awareness and support of the policy as well as the collaboration between SBAs and TBAs should be enhanced in Kwale.

  8. A qualitative study exploring newborn care behaviours after home births in rural Ethiopia: implications for adoption of essential interventions for saving newborn lives.

    Science.gov (United States)

    Salasibew, Mihretab Melesse; Filteau, Suzanne; Marchant, Tanya

    2014-12-12

    Ethiopia is among seven high-mortality countries which have achieved the fourth millennium development goal with over two-thirds reduction in under-five mortality rate. However, the proportion of neonatal deaths continues to rise and recent studies reported low coverage of the essential interventions saving newborn lives. In the context of low uptake of health facility delivery, it is relevant to explore routine practices during home deliveries and, in this study, we explored the sequence of immediate newborn care practices and associated beliefs following home deliveries in rural communities in Ethiopia. Between April-May 2013, we conducted 26 semi-structured interviews and 2 focus group discussions with eligible mothers, as well as a key informant interview with a local expert in traditional newborn care practices in rural Basona woreda (district) near the urban town of Debrebirhan, 120 km from Addis Ababa, Ethiopia. The most frequently cited sequence of newborn care practices reported by mothers with home deliveries in the rural Basona woreda was to tie the cord, immediately bath then dry the newborn, practice 'Lanka mansat' (local traditional practice on newborns), give pre-lacteal feeding and then initiate breastfeeding. For 'Lanka mansat', the traditional birth attendant applies mild pressure inside the baby's mouth on the soft palate using her index finger. This is performed believing that the baby will have 'better voice' and 'speak clearly' later in life. Coverage figures fail to tell the whole story as to why some essential interventions are not practiced and, in this study, we identified established norms or routines within the rural communities that determine the sequence of newborn care practices following home births. This might explain why some mothers delay initiation of breastfeeding and implementation of other recommended essential interventions saving newborn lives. An in-depth understanding of established routines is necessary, and community

  9. Women's motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis

    NARCIS (Netherlands)

    Hollander, Martine; de Miranda, Esteriek; van Dillen, Jeroen; de Graaf, Irene; Vandenbussche, Frank; Holten, Lianne

    2017-01-01

    Background: Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. Until now there were no qualitative data on women's motivations for these choices in the Dutch maternity care system where integrated midwifery care and home birth are regular options

  10. Medicaid program; state plan home and community-based services, 5-year period for waivers, provider payment reassignment, and home and community-based setting requirements for Community First Choice and home and community-based services (HCBS) waivers. Final rule.

    Science.gov (United States)

    2014-01-16

    This final rule amends the Medicaid regulations to define and describe state plan section 1915(i) home and community-based services (HCBS) under the Social Security Act (the Act) amended by the Affordable Care Act. This rule offers states new flexibilities in providing necessary and appropriate services to elderly and disabled populations. This rule describes Medicaid coverage of the optional state plan benefit to furnish home and community based-services and draw federal matching funds. This rule also provides for a 5-year duration for certain demonstration projects or waivers at the discretion of the Secretary, when they provide medical assistance for individuals dually eligible for Medicaid and Medicare benefits, includes payment reassignment provisions because state Medicaid programs often operate as the primary or only payer for the class of practitioners that includes HCBS providers, and amends Medicaid regulations to provide home and community-based setting requirements related to the Affordable Care Act for Community First Choice State plan option. This final rule also makes several important changes to the regulations implementing Medicaid 1915(c) HCBS waivers.

  11. Harnn Natural Home Spa Business Plan

    OpenAIRE

    Kusol, Chompunuch

    2008-01-01

    Home Spa Partnership is looking for the amount of 50,000 GBP from an investor to invest in the business. The Company offers 20% of its authorised share capital for 17,500 GBP and the preference shares amounting to 32,500 GBP. This amount will be brought into the infrastructures and initial overhead cost for the start-up Thai spa business in the UK under 'Harnn Natural Home Spa' brand. The Company Home Spa Partnership was incorporated in July 2008 with issued share capital of 80,000...

  12. Longing for home: displacement, memory and identity.

    Science.gov (United States)

    Ben-Yoseph, Miriam

    2005-01-01

    This article focuses on the relationship between the country of birth and the ability of the individual from that country to create a sense of home, identity and belonging in other countries and cultures. What is home? Is home the place where you were born and raised, where your parents live or where they are buried? Is home the place from where you were dislocated or where you live now? What does longing for home mean? The author draws on theory to address these questions but her personal story plays a prominent part.

  13. Folklore information from Assam for family planning and birth control.

    Science.gov (United States)

    Tiwari, K C; Majumder, R; Bhattacharjee, S

    1982-11-01

    The author collected folklore information on herbal treatments to control fertility from different parts of Assam, India. Temporary methods of birth control include Cissampelos pareira L. in combination with Piper nigrum L., root of Mimosa pudica L. and Hibiscus rosa-sinensis L. Plants used for permanent sterilization include Plumbago zeylanica L., Heliotropium indicum L., Salmalia malabrica, Hibiscus rosa-sinensis L., Plumeria rubra L., Bambusa rundinacea. Abortion is achieved through use of Osbeckia nepalensis or Carica papaya L. in combination with resin from Ferula narthex Boiss. It is concluded that there is tremendous scope for the collection of folklore about medicine, family planning agents, and other treatments from Assam and surrounding areas. Such a project requires proper understanding between the survey team and local people, tactful behavior, and a significant amount of time. Monetary rewards can also be helpful for obtaining information from potential respondents.

  14. Deliveries in maternity homes in Norway: results from a 2-year prospective study.

    Science.gov (United States)

    Schmidt, Nina; Abelsen, Birgit; Øian, Pål

    2002-08-01

    The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway. A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum. The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection. Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.

  15. Ornamental Plants of Home Garden along the Coridor of Kopendukuh Village, Banyuwangi, East Java-Indonesia as a Basis for Ecotourism Planning

    Directory of Open Access Journals (Sweden)

    Maic A.L. Sihombing

    2015-02-01

    Full Text Available Home garden is a habitat for many plants species which are important in planning and management of tourism in rural area. Ornamental plants have crucial function to increase the appearance of homes and buildings through landscaping. The purpose of this study is to analyze ornamental plants species which grow in the home garden along the corridor of Kopendukuh Village as one of the potential attractions of tourism development. The observation of ornamental plants diversity was carried out at home gardens along the rural coridor of Kopendukuh Village. Totally, there are about 10 home gardens were assessed. In each home gardens, plans species were recorded and identified systematically. Qualitative analysis was performed using analysis of sociability, vitality, and periodicity. Result of the survey confirm that home garden is home of about 40 ornamental plants species. These species came from 24 family. About 59% of the ornamental species was classified as individual plant species live in small groups, 28% of ornamental plant was classified as shrubs. About 65% of are ornamental plant without flowers and seeds.  The diversity of plants in home garden needs special attention, especially in order to increase settlement visual quality. Keywords: Kopendukuh, ornamental plant, sociability, vitality, periodicity.

  16. Patient Satisfaction With Maternity Waiting Homes in Liberia: A Case Study During the Ebola Outbreak.

    Science.gov (United States)

    Lori, Jody R; Munro-Kramer, Michelle L; Shifman, Jordan; Amarah, Patricia N M; Williams, Garfee

    2017-03-01

    Liberia in West Africa has one of the highest maternal mortality ratios in the world (990/100,000 live births). Many women in Liberia live in rural, remote villages with little access to safe maternity services. The World Health Organization has identified maternity waiting homes (MWHs) as one strategy to minimize the barrier of distance in accessing a skilled birth attendant. However, limited data exist on satisfaction with MWHs or maternal health care in Liberia. This mixed-methods case study examines women's satisfaction with their stay at a MWH and compares utilization rates before and during the Ebola outbreak. From 2012 to 2014, 650 women who stayed at one of 6 MWHs in rural Liberia during the perinatal or postnatal period were surveyed. Additionally, 60 semi-structured interviews were conducted with traditional providers, skilled birth attendants, and women utilizing the MWHs. Quantitative analyses assessed satisfaction rates before and during the Ebola outbreak. Content analysis of semi-structured interviews supplemented the quantitative data and provided a lens into the elements of satisfaction with the MWHs. The majority of women who utilized the MWHs stated they would suggest the MWH to a friend or relative who was pregnant (99.5%), and nearly all would utilize the home again (98.8%). Although satisfaction with the MWHs significantly decreased during the Ebola outbreak (P Liberia are generally satisfied with their experience and plan to use an MWH again during future pregnancies to access a skilled birth attendant for birth. Women are also willing to encourage family and friends to use MWHs. © 2017 by the American College of Nurse-Midwives.

  17. Is home delivery safe for all involved? A new arrival breaks grandma's heart. Literally.

    Science.gov (United States)

    Doolub, Gemina; Daniels, Matthew J; Ormerod, Oliver

    2011-12-01

    Home birth is becoming increasingly popular. Labour in the privacy and comfort of a familiar environment has clear appeal. Home birth is usually as safe for low-risk women with appropriate prenatal care. Yet events during delivery can be unpredictable and may be stressful for unprepared family members. Here we report a case of Tako-tsubo cardiomyopathy, also known as broken-heart syndrome, in a relative attending an impromptu home delivery. Thus, while home delivery is generally safe for the mother we ask: is it safe for everyone involved?

  18. Postpartum Care Services and Birth Features of The Women Who Gave Birth in Burdur in 2009

    Directory of Open Access Journals (Sweden)

    Binali Catak

    2011-10-01

    Full Text Available AIM: In the study, it is aimed to evaluate postpartum care services and the delivery characteristics of the women who gave birth in Burdur in 2009. MATERIAL AND METHODS: In the study, the data is used about \\\\\\"Birth and Postpartum Care\\\\\\" of the research \\\\\\" Birth, Postpartum Care Services, and Nutritional Status of Children of the women who are giving birth in Burdur in 2009 \\\\\\". The population of the planned cross-sectional study are women who gave birth in Burdur in 2009. For the determination of the population, a list of women who gave birth in 2009 were used which was requested from family physicians. The reported number of women was 2318. The sample size representing the population to be reached was calculated as 1179. The data were collected using face-to-face interviews and were analyzed using SPSS package program. RESULTS: The mean age of the women was 27.1 (± 5.5 with an average size of households 4.3 (± 1.2. 22.1% of the women live with large families and 64.4% live in the village. 8.0% of the women were relatives with their husbands, 52.8% have arranged marriage and 1.3% have no official marriage. 1 in every 4 women is housewive, 1.8% have no formal education, 76.4% have no available social and 7.1% have no available health insurance. The average number of pregnancies of women is 2.1 (± 1.2 and number of children is 1.8 (± 0.8. Spontaneous abortion, induced abortion, stillbirth and death rate of children under 5 years of age are respectively 16.4%, 6.6%, 2.7%, 3.4%. 99.8% of the women have given birth in hospital, % 67.3 had medical supervision, 62.8% had cesarean birth. The average days of hospital stay after birth is 1.9 (± 3.1. 4.8% of the women after being discharged from the hospital have not received Postpartum Care (DSB. Of the women who have received DSB service, 2.2% had taken this service at home by family physician / family health stuff, 33.9% by obstetrician in practice. 92.2% of the women 1 time, 15

  19. Increased traffic exposure and negative birth outcomes: a prospective cohort in Australia

    Directory of Open Access Journals (Sweden)

    Wilson Lee-Ann

    2011-04-01

    Full Text Available Abstract Background Pregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland. Methods We examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, highways and main roads. Results There were no associations with distance to road. A greater number of freeways and main roads around the home were associated with a shorter gestation time. There were no negative impacts on birth weight, birth length or head circumference after adjusting for gestation. The negative effects on gestation were largely due to main roads within 400 metres of the home. For every 10 extra main roads within 400 metres of the home, gestation time was reduced by 1.1% (95% CI: -1.7, -0.5; p-value = 0.001. Conclusions Our results add weight to the association between exposure to traffic and reduced gestation time. This effect may be due to the chemical toxins in traffic pollutants, or because of disturbed sleep due to traffic noise.

  20. The home-based maternal record: a tool for family involvement in health care.

    Science.gov (United States)

    Shah, P M; Shah, K P; Belsey, M A

    1988-04-01

    The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.

  1. European birth cohorts for environmental health research

    DEFF Research Database (Denmark)

    Vrijheid, Martine; Casas, Maribel; Bergström, Anna

    2012-01-01

    Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning.......Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning....

  2. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  3. "Giving us hope": Parent and neonatal staff views and expectations of a planned family-centred discharge process (Train-to-Home).

    Science.gov (United States)

    Ingram, Jenny; Redshaw, Maggie; Manns, Sarah; Beasant, Lucy; Johnson, Debbie; Fleming, Peter; Pontin, David

    2017-08-01

    Preparing families and preterm infants for discharge is relatively unstructured in many UK neonatal units (NNUs). Family-centred neonatal care and discharge planning are recommended but variable. Qualitative interviews with 37 parents of infants in NNUs, and 18 nursing staff and 5 neonatal consultants explored their views of discharge planning and perceptions of a planned family-centred discharge process (Train-to-Home). Train-to-Home facilitates communication between staff and parents throughout the neonatal stay, using a laminated train and parent booklets. Parents were overwhelmingly positive about Train-to-Home. They described being given hope, feeling in control and having something visual to show their baby's progress. They reported positive involvement of fathers and families, how predicted discharge dates helped them prepare for home and ways staff engaged with Train-to-Home when communicating with them. Nursing staff reactions were mixed-some were uncertain about when to use it, but found the visual images powerful. Medical staff in all NNUs were positive about the intervention recognizing that it helped in communicating better with parents. Using a parent-centred approach to communication and informing parents about the needs and progress of their preterm infant in hospital is welcomed by parents and many staff. This approach meets the recommended prioritization of family-centred care for such families. Predicted discharge dates helped parents prepare for home, and the ways staff engaged with Train-to-Home when communicating with them helped them feel more confident as well as having something visual to show their baby's progress. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  4. Impact of a mobile health aplication in the nursing care plan compliance of a home care service in Belo Horizonte, Minas Gerais, Brazil.

    Science.gov (United States)

    de Britto, Felipe A; Martins, Tatiana B; Landsberg, Gustavo A P

    2015-01-01

    To assess impact of a mobile health solution in the nursing care plan compliance of a home care service. A retrospective cohort study was performed with 3,036 patients. Compliance rates before and after the implementation were compared. After the implementation of a mobile health aplication, compliance with the nursing care plan increased from 53% to 94%. The system reduced IT spending, increased the nursing team efficiency and prevented planned hiring. The use of a mobile health solution with geolocating feature by a nursing home care team increased compliance to the care plan.

  5. Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne

    Directory of Open Access Journals (Sweden)

    Donohue Lisa

    2006-12-01

    Full Text Available Abstract Background In the 1980s there was substantial interest in early pregnancy and pre-pregnancy interventions to increase birth weight and reduce preterm birth. We developed an inter-pregnancy intervention, implemented in a randomised controlled trial, to be provided by midwives at home soon after women's first birth. Methods MCH nurses invited women to take part during their home visit to new mothers. Women's contact details, with their permission, were passed to the study midwife. She had a randomisation schedule to which women's names were added before she met the women or their partners. All women recruited had a home visit from the study midwife with a discussion of their first pregnancy, labour and birth and the postpartum experience. Women in the intervention arm received in addition a pre-pregnancy intervention with discussion of social, health or lifestyle problems, preparation and timing for pregnancy, family history, rubella immunisation, referrals for health problems, and a reminder card. The primary outcome was defined as a birth weight difference in the second birth of 100 g (one-sided in favour of the intervention. Additional data collected were gestational age, perinatal deaths and birth defects. Analyses used EPI-INFO and STATA. Results Intervention and comparison groups were comparable on socioeconomic factors, prior reproductive history and first birth outcomes. Infant birth weight in the second birth was lower (-97.4 g, among infants in the intervention arm. There were no significant differences between intervention and comparison arms in the proportion of women having a preterm birth, an infant with low birthweight, or an infant with a birth weight th percentile. There were more adverse outcomes in the intervention arm: ten births Conclusion As the primary outcome was envisaged to be either improved birth weight or no effect, the study was not designed to identify the alternative outcome with confidence. Despite

  6. Reaching mothers and babies with early postnatal home visits: the implementation realities of achieving high coverage in large-scale programs.

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin

    Full Text Available BACKGROUND: Nearly half of births in low-income countries occur without a skilled attendant, and even fewer mothers and babies have postnatal contact with providers who can deliver preventive or curative services that save lives. Community-based maternal and newborn care programs with postnatal home visits have been tested in Bangladesh, Malawi, and Nepal. This paper examines coverage and content of home visits in pilot areas and factors associated with receipt of postnatal visits. METHODS: Using data from cross-sectional surveys of women with live births (Bangladesh 398, Malawi: 900, Nepal: 615, generalized linear models were used to assess the strength of association between three factors - receipt of home visits during pregnancy, birth place, birth notification - and receipt of home visits within three days after birth. Meta-analytic techniques were used to generate pooled relative risks for each factor adjusting for other independent variables, maternal age, and education. FINDINGS: The proportion of mothers and newborns receiving home visits within three days after birth was 57% in Bangladesh, 11% in Malawi, and 50% in Nepal. Mothers and newborns were more likely to receive a postnatal home visit within three days if the mother received at least one home visit during pregnancy (OR2.18, CI1.46-3.25, the birth occurred outside a facility (OR1.48, CI1.28-1.73, and the mother reported a CHW was notified of the birth (OR2.66, CI1.40-5.08. Checking the cord was the most frequently reported action; most mothers reported at least one action for newborns. CONCLUSIONS: Reaching mothers and babies with home visits during pregnancy and within three days after birth is achievable using existing community health systems if workers are available; linked to communities; and receive training, supplies, and supervision. In all settings, programs must evaluate what community delivery systems can handle and how to best utilize them to improve postnatal care

  7. Influence of environmental factors on birth weight variability of ...

    African Journals Online (AJOL)

    Administrator

    2011-05-30

    May 30, 2011 ... significant (P < 0.05). Type of birth also had effect on the body weight of lambs at birth in both Pirot and ... Key words: Environmental factors, birth weight variability, indigenous sheep. ... breeding plans to improve production.

  8. Birthing Healthy Babies (A Minute of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    Birth defects are common, costly, and critical. If you're pregnant or planning to get pregnant, you can take steps to improve your chances of giving birth to a healthy child. This podcast discusses ways to prevent birth defects.

  9. Family planning management for the migrant population in sending areas. Urban family planning programme.

    Science.gov (United States)

    1997-02-01

    This brief article was adapted from a report by the Longchang County Government, Sichuan Province, China, at the National Conference on Urban Family Planning Programs. The Longchang County family planning program has shifted emphasis since 1990 toward management of out-migrant workers. Overpopulation in the family planning region resulted in each person having about one-sixth of an acre (0.6 mu) of land. There were about 200,000 surplus rural workers. 75,000 migrants left the region in 1995, of which 70,300 had signed birth control contracts and had received family planning certificates. Family planning township agencies in Longchang County increased their IEC and counseling services for migrants and their families. The Longchang County family planning program maintained family planning contacts in receiving areas in order to obtain pregnancy and birth information on the migrant population. During 1991-95 the number of unplanned births declined from 1394 to 71, and 97% of the births were planned.

  10. A centile chart for birth weight for an urban population of the Western ...

    African Journals Online (AJOL)

    distribution of birth weight at each week of gestation from. 28 to 42 weeks was ... A comparison of the distribution of birth weight in the ... The increased perinatal death rate of these ... lower socio-economic class, no home deliveries are done in.

  11. Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long-term care settings: a cross-sectional survey.

    Science.gov (United States)

    Beck, Esther-Ruth; McIlfatrick, Sonja; Hasson, Felicity; Leavey, Gerry

    2017-09-01

    To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this. A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015. Nursing home managers in a region in the UK (n = 178). A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours. Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia. Increased cognisance of the context in which advance care

  12. Trends in Out-of-Hospital Births in the United States, 1990-2012

    Science.gov (United States)

    ... to American Indian women, and 0.54% to Asian or Pacific Islander women. In 2012, out-of-hospital births comprised 3%– ... the United States choose home birth. J Midwifery Womens Health 54(2):119–26. 2009. Health Management Associates. Midwifery licensure and discipline program in Washington ...

  13. Gender issues in determining the service and research agenda for pregnancy and birth care: The case of home birth in the Netherlands

    NARCIS (Netherlands)

    Buitendijk, S.

    2011-01-01

    Worldwide, there are two conceptual models of pregnancy and child birth. In the first, 'male' model, pregnancy and the birth of a baby are biomedical processes. In the second, 'female' model, pregnancy and child birth are major psychosocial events for the woman. The research agenda of obstetricians

  14. Autonomy in place of birth: a concept analysis.

    Science.gov (United States)

    Halfdansdottir, Berglind; Wilson, Margaret E; Hildingsson, Ingegerd; Olafsdottir, Olof A; Smarason, Alexander Kr; Sveinsdottir, Herdis

    2015-11-01

    This article examines one of the relevant concepts in the current debate on home birth-autonomy in place of birth-and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.

  15. Exploring new operational research opportunities within the Home Care context: the chemotherapy at home.

    Science.gov (United States)

    Chahed, Salma; Marcon, Eric; Sahin, Evren; Feillet, Dominique; Dallery, Yves

    2009-06-01

    Home Care (HC) services provide complex and coordinated medical and paramedical care to patients at their homes. As health care services move into the home setting, the need for developing innovative approaches that improve the efficiency of home care organizations increases. We first conduct a literature review of investigations dealing with operation planning within the area of home care management. We then address a particular issue dealing with the planning of operations related to chemotherapy at home as it is an emergent problem in the French context. Our interest is focused on issues specific to the anti-cancer drug supply chain. We identify various models that can be developed and analyze one of them.

  16. Maternal mortality in rural south Ethiopia: outcomes of community-based birth registration by health extension workers.

    Directory of Open Access Journals (Sweden)

    Yaliso Yaya

    Full Text Available Rural communities in low-income countries lack vital registrations to track birth outcomes. We aimed to examine the feasibility of community-based birth registration and measure maternal mortality ratio (MMR in rural south Ethiopia.In 2010, health extension workers (HEWs registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria. One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke.We registered 10,987 births (81·4% of expected 13,492 births with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71·6% (1,718 were registered with similar MMRs (474 vs. 439 between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths occurred at home. Ninety percent (9,863 births were at home, 4% (430 at health posts, 2·5% (282 at health centres, and 3·5% (412 in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0·051 and the villages had no road access (946 vs. 410; p= 0·039. The validation helped to increase the registration coverage by 10% through feedback discussions.It is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home.

  17. Maternal Mortality in Rural South Ethiopia: Outcomes of Community-Based Birth Registration by Health Extension Workers

    Science.gov (United States)

    Yaya, Yaliso; Data, Tadesse; Lindtjørn, Bernt

    2015-01-01

    Introduction Rural communities in low-income countries lack vital registrations to track birth outcomes. We aimed to examine the feasibility of community-based birth registration and measure maternal mortality ratio (MMR) in rural south Ethiopia. Methods In 2010, health extension workers (HEWs) registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria). One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke. Results We registered 10,987 births (81·4% of expected 13,492 births) with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71·6% (1,718) were registered with similar MMRs (474 vs. 439) between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths) occurred at home. Ninety percent (9,863 births) were at home, 4% (430) at health posts, 2·5% (282) at health centres, and 3·5% (412) in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0·051) and the villages had no road access (946 vs. 410; p= 0·039). The validation helped to increase the registration coverage by 10% through feedback discussions. Conclusion It is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home. PMID:25799229

  18. Path Planning Method for UUV Homing and Docking in Movement Disorders Environment

    Directory of Open Access Journals (Sweden)

    Zheping Yan

    2014-01-01

    Full Text Available Path planning method for unmanned underwater vehicles (UUV homing and docking in movement disorders environment is proposed in this paper. Firstly, cost function is proposed for path planning. Then, a novel particle swarm optimization (NPSO is proposed and applied to find the waypoint with minimum value of cost function. Then, a strategy for UUV enters into the mother vessel with a fixed angle being proposed. Finally, the test function is introduced to analyze the performance of NPSO and compare with basic particle swarm optimization (BPSO, inertia weight particle swarm optimization (LWPSO, EPSO, and time-varying acceleration coefficient (TVAC. It has turned out that, for unimodal functions, NPSO performed better searching accuracy and stability than other algorithms, and, for multimodal functions, the performance of NPSO is similar to TVAC. Then, the simulation of UUV path planning is presented, and it showed that, with the strategy proposed in this paper, UUV can dodge obstacles and threats, and search for the efficiency path.

  19. The Meaning of Giving Birth: Voices of Hmong Women Living in Vietnam.

    Science.gov (United States)

    Corbett, Cheryl A; Callister, Lynn Clark; Gettys, Jamie Peterson; Hickman, Jacob R

    Increasing knowledge about the sociocultural context of birth is essential to promote culturally sensitive nursing care. This qualitative study provides an ethnographic view of the perspectives on birthing of Hmong mothers living in the highlands of Vietnam. Unique cultural beliefs exist in Hmong culture about the spiritual and physical world as well as ritual practices associated with childbearing. This includes variations of ancestor worship, reincarnation, and healing practices by shamans. Traditionally, Hmong families take an active role in childbirth with birth frequently occurring in the home. Situated within a large collaborative anthropology project, a convenience sample of 8 Hmong women, who had recently given birth, were interviewed regarding the perinatal experience. In addition, ethnic traditional birth attendants (midwives) and other village women contributed perspectives providing richly descriptive data. This ethnographic study was conducted during 6 weeks of immersed participant observation with primary data collection carried out through fieldwork. Data were analyzed to derive cultural themes from interviews and observations. Significant themes included (1) valuing motherhood, (2) laboring and giving birth silently, (3) giving birth within the comfort of home and family, (4) feeling capable of birthing well, (5) feeling anxiety to provide for another child, and (6) embracing cultural traditions. Listening to the voices of Hmong women enhances understanding of the meaning of childbirth. Gaining greater understanding of Hmong cultural beliefs and practices can ensure childbearing women receive respectful, safe, and quality care.

  20. Autonomy, Educational Plans, and Self-Esteem in Institution-Reared and Home-Reared Teenagers in Estonia

    Science.gov (United States)

    Tulviste, Tiia

    2011-01-01

    The study examines autonomy, self-esteem, and educational plans for the future of 109 institution-reared and 106 home-reared teenagers (15-19 years). Teenagers were asked to complete the Teen Timetable Scale (Feldman & Rosenthal), two Emotional Autonomy Scales (Steinberg & Silverberg), the Rosenberg Self-Esteem Scale, and answer questions…

  1. Birthplace choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups.

    Science.gov (United States)

    Hinton, Lisa; Dumelow, Carol; Rowe, Rachel; Hollowell, Jennifer

    2018-01-08

    Current clinical guidelines and national policy in England support offering 'low risk' women a choice of birth setting. Options include: home, free-standing midwifery unit (FMU), alongside midwifery unit (AMU) or obstetric unit (OU). This study, which is part of a broader project designed to inform policy on 'choice' in relation to childbirth, aimed to provide evidence on UK women's experiences of choice and decision-making in the period since the publication of the Birthplace findings (2011) and new NICE guidelines (2014). This paper reports on findings relating to women's information needs when making decisions about where to give birth. A qualitative focus group study including 69 women in the last trimester of pregnancy in England in 2015-16. Seven focus groups were conducted online via a bespoke web portal, and one was face-to-face. To explore different aspects of women's experience, each group included women with specific characteristics or options; planning a home birth, living in areas with lots of choice, living in areas with limited choice, first time mothers, living close to a FMU, living in opt-out AMU areas, living in socioeconomically disadvantaged areas and planning to give birth in an OU. Focus group transcripts were analysed thematically. Women drew on multiple sources when making choices about where to give birth. Sources included; the Internet, friends' recommendations and experiences, antenatal classes and their own personal experiences. Their midwife was not the main source of information. Women wanted the option to discuss and consider their birth preferences throughout their pregnancy, not at a fixed point. Birthplace choice is informed by many factors. Women may encounter fewer overt obstacles to exercising choice than in the past, but women do not consistently receive information about birthplace options from their midwife at a time and in a manner that they find helpful. Introducing options early in pregnancy, but deferring decision

  2. Changing messages about place of birth in Mother and Baby magazine between 1956 and 1992.

    Science.gov (United States)

    McIntosh, Tania

    2017-11-01

    this paper explores changing messages about place of birth offered to women by Mother and Baby magazine, a UK publication aimed at a general readership DESIGN: the research uses an historical perspective to explore changing messages about place of birth in Mother and Baby magazine between 1956-1992. It analyses the content and medium of the magazine through a narrative and semiotic approach. the UK between the mid-1950s and 1990s. The period was a time of significant change in the maternity services, at both a philosophical and organisational level with a move towards hospital rather than home birth and a dominant discourse which privileged medical models of care over social ones. producers and consumers of Mother and Baby magazine FINDINGS: Mother and Baby moved from an assumption of home birth to a focus on hospital birth, reflecting national changes in policy. The magazine moved from a social to a risk focused medical view of birth, with an emphasis on the safety of the baby and the sacrifice of the mother. These changes can be traced through both the organisation and the language of content between 1956 and 1992. However, home birth was always offered to readers as a viable, if increasingly niche, option. This reflected the magazine's need to appeal to its readers as consumers; both in consumption of the magazine and of maternity care. the evidence suggests that Mother and Baby magazine mirrored elements of the prevailing policy discourse around place of birth. However, it always gave space to other narratives. In doing so it reminds us of the complexity about how messages about labour and birth are told and received. It gives insight into ways in which the media lead and reflect change and the impact this might have on decision making by women. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Term infants born at home in Peru are less likely to be hospitalised in the neonatal period than those born in hospital.

    Science.gov (United States)

    Lavin, Tina; Preen, David B

    2017-08-01

    More than 50% of women worldwide give birth at home, but little is known about home birth and subsequent neonatal hospitalisation. The objective of the study was to investigate home birth and neonatal hospitalisation of term neonates in Peru. The relationship between birth setting [home - with or without skilled birth attendant (SBA), health centre, hospital] and neonatal hospitalisation (n = 1656) and incubator care (n = 1651) was investigated using data from the 2002 Young Lives Study. Infants were sampled from 20 sentinel sites across Peru. At each sentinel site 100 households with children aged 6-18 months were randomly sampled (therefore the sample only captured children surviving to 6 months of age). Multivariate regression modelling was used with models adjusted for a range of demographic and clinical factors. After adjustment, the odds of hospitalisation were lower in neonates born at home (with SBA OR 0.20, 95% CI 0.0-0.8, p = 0.021; without SBA OR = 0.4, 95% CI 0.2-0.7, p = 0.002) than in those born in hospital. Socio-demographic factors such as ethnicity, rural living, education, socio-economic status and access to transport did not influence neonatal hospitalisation, time in hospital, incubator care or time under incubator care. Neonates born at home were less likely to be hospitalised after birth owing to neonatal morbidity than neonates born in hospital. It is unclear whether this finding reflects poorer accessibility to hospital care for neonates born at home, or if neonates born at home required hospitalisation less frequently than neonates born in hospital owing to lower neonatal morbidity or other factors such as lower rates of medical intervention for home births. Further research is needed to explore the underlying mechanisms of these findings.

  4. Nonspecific effect of BCG vaccination at birth on early childhood infections

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper; Birk, Nina Marie; Nissen, Thomas N

    2016-01-01

    BACKGROUND: Childhood infections are common and Bacillus Calmette-Guérin (BCG) vaccination at birth may prevent these via nonspecific effects. METHODS: A randomized, clinical multicenter trial. All women planning to give birth (n = 16,521) at the three study sites were invited during the recruitm......BACKGROUND: Childhood infections are common and Bacillus Calmette-Guérin (BCG) vaccination at birth may prevent these via nonspecific effects. METHODS: A randomized, clinical multicenter trial. All women planning to give birth (n = 16,521) at the three study sites were invited during...... during the first 3 mo....

  5. Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data.

    Science.gov (United States)

    Montagu, Dominic; Yamey, Gavin; Visconti, Adam; Harding, April; Yoong, Joanne

    2011-02-28

    In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed "not necessary" by a household decision maker. Among the poorest women, "not necessary" was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. In developing countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to

  6. Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data.

    Directory of Open Access Journals (Sweden)

    Dominic Montagu

    2011-02-01

    Full Text Available In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home.We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA, where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA; 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed "not necessary" by a household decision maker. Among the poorest women, "not necessary" was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended.In developing countries, most poor women deliver at home. This suggests that, at least in the near term

  7. Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data

    Science.gov (United States)

    Montagu, Dominic; Yamey, Gavin; Visconti, Adam; Harding, April; Yoong, Joanne

    2011-01-01

    Background In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. Methodology/Principal Findings We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed “not necessary” by a household decision maker. Among the poorest women, “not necessary” was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. Conclusions In developing countries, most poor women deliver at home

  8. The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study.

    Science.gov (United States)

    Wang, Ning; Yu, Ping; Hailey, David

    2015-08-01

    The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, Ppaper-based system (Ppaper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright

  9. Using machine learning algorithms to guide rehabilitation planning for home care clients.

    Science.gov (United States)

    Zhu, Mu; Zhang, Zhanyang; Hirdes, John P; Stolee, Paul

    2007-12-20

    Targeting older clients for rehabilitation is a clinical challenge and a research priority. We investigate the potential of machine learning algorithms - Support Vector Machine (SVM) and K-Nearest Neighbors (KNN) - to guide rehabilitation planning for home care clients. This study is a secondary analysis of data on 24,724 longer-term clients from eight home care programs in Ontario. Data were collected with the RAI-HC assessment system, in which the Activities of Daily Living Clinical Assessment Protocol (ADLCAP) is used to identify clients with rehabilitation potential. For study purposes, a client is defined as having rehabilitation potential if there was: i) improvement in ADL functioning, or ii) discharge home. SVM and KNN results are compared with those obtained using the ADLCAP. For comparison, the machine learning algorithms use the same functional and health status indicators as the ADLCAP. The KNN and SVM algorithms achieved similar substantially improved performance over the ADLCAP, although false positive and false negative rates were still fairly high (FP > .18, FN > .34 versus FP > .29, FN. > .58 for ADLCAP). Results are used to suggest potential revisions to the ADLCAP. Machine learning algorithms achieved superior predictions than the current protocol. Machine learning results are less readily interpretable, but can also be used to guide development of improved clinical protocols.

  10. Home care after early discharge: impact on healthy mothers and newborns.

    Science.gov (United States)

    Askelsdottir, Björk; Lam-de Jonge, Willemien; Edman, Gunnar; Wiklund, Ingela

    2013-08-01

    to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth. retrospective case-control study. a labour ward unit in Stockholm, Sweden handling both normal and complicated births. 96 women with single, uncomplicated pregnancies and births, and their healthy newborns. early discharge at 12-24 hours post partum with 2-3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (n=51). mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded. women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (p=0.021). Contact between the mother, newborn and partner did not differ between the groups. early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Governance of Land Use Planning to Reduce Fire Risk to Homes Mediterranean France and California

    Directory of Open Access Journals (Sweden)

    Susan D. Kocher

    2017-03-01

    Full Text Available Wildfire is a natural part of forested Mediterranean systems. As humans continue to live and build housing in these areas, wildfire is a constant threat to homes and lives. The goal of this paper is to describe aspects of land-use planning that are used to reduce wildfire risk in institutionally divergent regions; southern France and California. By reviewing relevant legislation and planning documents and conducting in person interviews with fire and planning professionals, we identify the institutions which participate in land use planning to reduce fire risk and the key laws and regulations that guide planning decisions. Our results indicate that France has a more centralized system for planning for fire, with national level entities heavily involved in local land use planning. California, on the other hand sees almost no federal oversite, and, while state law requires local plans to include wildfire risk, most fine grain decisions are left to local planners and decision makers. In both regions, however, we see a reliance on technical support provided from outside local jurisdictions. Increased coordination between local, regional, and national governments could improve land use planning in both locations.

  12. Ohio Department of Health Home

    Science.gov (United States)

    Business Award Flu Season Media button unselected Media button selected Data Stats button unselected Data unselected Contact Us button selected Start Talking Help Me Grow WIC (Women, Infants & Children) Office , sleep-related deaths and birth defects. Makes it easier for Ohio families to identify lead-safe homes

  13. Timing of birth for women with a twin pregnancy at term: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Haslam Ross R

    2010-10-01

    Full Text Available Abstract Background There is a well recognized risk of complications for both women and infants of a twin pregnancy, increasing beyond 37 weeks gestation. Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy, however, up to 50% of twins will be born after this time. The aims of this randomised trial are to assess whether elective birth at 37 weeks gestation compared with standard care in women with a twin pregnancy affects the risk of perinatal death, and serious infant complications. Methods/Design Design: Multicentred randomised trial. Inclusion Criteria: women with a twin pregnancy at 366 weeks or more without contraindication to continuation of pregnancy. Trial Entry & Randomisation: Following written informed consent, eligible women will be randomised from 36+6 weeks gestation. The randomisation schedule uses balanced variable blocks, with stratification for centre of birth and planned mode of birth. Women will be randomised to either elective birth or standard care. Treatment Schedules: Women allocated to the elective birth group will be planned for elective birth from 37 weeks gestation. Where the plan is for vaginal birth, this will involve induction of labour. Where the plan is for caesarean birth, this will involve elective caesarean section. For women allocated to standard care, birth will be planned for 38 weeks gestation or later. Where the plan is for vaginal birth, this will involve either awaiting the spontaneous onset of labour, or induction of labour if required. Where the plan is for caesarean birth, this will involve elective caesarean section (after 38 and as close to 39 weeks as possible. Primary Study Outcome: A composite of perinatal mortality or serious neonatal morbidity. Sample Size: 460 women with a twin pregnancy to show a reduction in the composite outcome from 16.3% to 6.7% with adjustment for the clustering of twin infants within mothers (p = 0.05, 80% power. Discussion This

  14. The Effect of Activity Restriction on Infant's Birth Weight and Gestational Age at Birth: PRAMS Data Analysis.

    Science.gov (United States)

    Omar, Abeer

    2018-01-01

    Activity restriction is extensively prescribed for pregnant women with major comorbidities despite the lack of evidence to support its effectiveness in preventing preterm birth or low birth weight. To determine the moderation effect of home activity restriction for more than a week on infant's birth weight and gestational age at birth for high-risk women with obstetrical and medical comorbidities. A secondary analysis of 2004-2008 New York Pregnancy Risk Assessment Monitoring System was conducted with 1426 high-risk women. High-risk group included 41% of women treated with activity restriction and 59% of those not treated with activity restriction. Women with preterm premature rupture of membrane (PPROM) who were treated with activity restriction had a lower infant birth weight ( b = -202.85, p = ≤.001) and gestational age at birth ( b = -.91, p = ≤.001) than those without activity restriction. However, women with preterm labor and hypertensive disorders of pregnancy who were not treated with activity restriction had lower infant gestational age at birth ( b = -96, p = ≤.01) and ( b = -92, p = ≤.001), respectively, compared to those who were treated with activity restriction. Findings suggest a contrary effect of activity restriction on infants born to women with PPROM, which is a major reason for prescribing activity restriction. The current study results may trigger the need to conduct randomized control trials to determine the effect of severity of activity restriction on maternal and infant outcomes.

  15. Planning of Efficient Wireless Access with IEEE 802.16 for Connecting Home Network to the Internet

    Directory of Open Access Journals (Sweden)

    Pichet Ritthisoonthorn

    2010-01-01

    Full Text Available The emergence of IEEE802.16 wireless standard technology (WiMAX has significantly increased the choice to operators for the provisioning of wireless broadband access network. WiMAX is being deployed to compliment with xDSL in underserved or lack of the broadband network area, in both developed and developing countries. Many incumbent operators in developing countries are considering the deployment of WiMAX as part of their broadband access strategy. This paper presents an efficient and simple method for planning of broadband fixed wireless access (BFWA with IEEE802.16 standard to support home connection to Internet. The study formulates the framework for planning both coverage and capacity designs. The relationship between coverage area and access rate from subscriber in each environment area is presented. The study also presents the throughput and channel capacity of IEEE802.16 in different access rates. An extensive analysis is performed and the results are applied to the real case study to demonstrate the practicality of using IEEE 802.16 for connecting home to Internet. Using empirical data and original subscriber traffic from measurement, it is shown that the BFWA with IEEE802.16 standard is a capacity limited system. The capacity of IEEE802.16 is related to different factors including frequency bandwidth, spectrum allocation, estimation of traffic per subscriber, and choice of adaptive modulation from subscriber terminal. The wireless access methods and procedures evolved in this research work and set out in this paper are shown to be well suited for planning BFWA system based on IEEE802.16 which supports broadband home to Internet connections.

  16. Women's persistent utilisation of unskilled birth attendants in ...

    African Journals Online (AJOL)

    ... facilities to address the discrepancy between antenatal attendance and delivery by skilled birth attendance. We hope that the information generated from this study will be used by the policy makers leading to appropriate interventions or strategies which will reduce the number of home deliveries and maternal deaths.

  17. Delivery practices, hygiene, birth attendance and neonatal infections ...

    African Journals Online (AJOL)

    Background: Drawing attention to home birth conditions and subsequent neonatal infections is a key starting point to reducing neonatal morbidity which are a main cause of mortality in sub-Saharan Africa. Objectives: To determine the proportion of respiratory, ophthalmic, and diarrhoeal infections in neonates; the proportion ...

  18. Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy.

    Science.gov (United States)

    Mendhi, Marvesh M; Cartmell, Kathleen B; Newman, Susan D; Premji, Shahirose; Pope, Charlene

    2018-05-21

    Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality. This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries. An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria. Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births. Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All

  19. Birthing Healthy Babies (A Minute of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2018-01-11

    Birth defects are common, costly, and critical. If you’re pregnant or planning to get pregnant, you can take steps to improve your chances of giving birth to a healthy child. This podcast discusses ways to prevent birth defects.  Created: 1/11/2018 by MMWR.   Date Released: 1/11/2018.

  20. Regeneració i homeòstasi a les planàries: gens i vies de senyalització implicats en l'organogènesi

    OpenAIRE

    González Sastre, Alejandro

    2017-01-01

    [cat] En aquesta tesi, titulada “Regeneració i homeòstasi a les planàries: gens i vies de senyalització implicats en l'organogènesi”, s’aprofundeix en l’estudi dels processos responsables de l’organogènesi a la planària d’aigua dolça Schmidtea mediterranea, tant durant la regeneració com durant l’homeòstasi. La planària d’aigua dolça Schmidtea mediterranea presenta una extraordinària capacitat de regeneració, gràcies a la presència d’una elevada quantitat de cèl·lules mare, els neoblasts, qu...

  1. Poverty, partner discord, and divergent accounts; a mixed methods account of births before arrival to health facilities in Morogoro Region, Tanzania.

    Science.gov (United States)

    McMahon, Shannon A; Chase, Rachel P; Winch, Peter J; Chebet, Joy J; Besana, Giulia V R; Mosha, Idda; Sheweji, Zaina; Kennedy, Caitlin E

    2016-09-27

    Births before arrival (BBA) to health care facilities are associated with higher rates of perinatal morbidity and mortality compared to facility deliveries or planned home births. Research on such births has been conducted in several high-income countries, but there are almost no studies from low-income settings where a majority of maternal and newborn deaths occur. Drawing on a household survey of women and in-depth interviews with women and their partners, we examined the experience of BBA in rural districts of Morogoro Region, Tanzania. Among survey respondents, 59 births (4 %) were classified as BBAs. Most of these births occurred in the presence of a family member (47 %) or traditional birth attendant (24 %). Low socioeconomic status was the strongest predictor of BBA. After controlling for wealth via matching, high parity and a low number of antenatal care (ANC) visits retained statistical significance. While these variables are useful indicators of which women are at greater risk of BBA, their predictive power is limited in a context where many women are poor, multiparous, and make multiple ANC visits. In qualitative interviews, stories of BBAs included themes of partner disagreement regarding when to depart for facilities and financial or logistical constraints that underpinned departure delays. Women described wanting to depart earlier to facilities than partners. As efforts continue to promote facility birth, we highlight the financial demands associated with facility delivery and the potential for these demands to place women at a heightened risk for BBAs.

  2. [Birth rates evolution in Spain. Birth trends in Spain from 1941 to 2010].

    Science.gov (United States)

    Andrés de Llano, J M; Alberola López, S; Garmendia Leiza, J R; Quiñones Rubio, C; Cancho Candela, R; Ramalle-Gómara, E

    2015-01-01

    The aim of this study was to analyse trends of births in Spain and its Autonomous Communities (CCAA) over a 70 year period (1941-2010). The crude birth rates per 1,000 inhabitants/year were calculated by CCAA using Joinpoint regression models. Change points in trend and annual percentage of change (APC) were identified. The distribution of 38,160,305 births between 1941 and 2010 shows important changes in trends both nationally and among the CCAA. There is a general pattern for the whole country, with 5 turning points being identified with changes in trend and annual percentage change (APC). Differences are also found among regions. The analysis of trends in birth rates and the annual rates of change should enable public health authorities to properly plan pediatric care resources in our country. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  3. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

    Directory of Open Access Journals (Sweden)

    Fiifi Amoako Johnson

    Full Text Available The Community-based Health Planning and Services (CHPS initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas.Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km.Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

  4. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

    Science.gov (United States)

    Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Matthews, Zoe; Harfoot, Andrew J P; Nyarko, Philomena; Baschieri, Angela; Gething, Peter W; Falkingham, Jane; Atkinson, Peter M

    2015-01-01

    The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

  5. Using the community-based health planning and services program to promote skilled delivery in rural Ghana: socio-demographic factors that influence women utilization of skilled attendants at birth in Northern Ghana

    OpenAIRE

    Sakeah, Evelyn; Doctor, Henry V; McCloskey, Lois; Bernstein, Judith; Yeboah-Antwi, Kojo; Mills, Samuel

    2014-01-01

    Background The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as mi...

  6. Passing through - reasons why migrant doctors in Ireland plan to stay, return home or migrate onwards to new destination countries.

    Science.gov (United States)

    Brugha, Ruairí; McAleese, Sara; Dicker, Pat; Tyrrell, Ella; Thomas, Steve; Normand, Charles; Humphries, Niamh

    2016-06-30

    International recruitment is a common strategy used by high-income countries to meet their medical workforce needs. Ireland, despite training sufficient doctors to meet its internal demand, continues to be heavily dependent on foreign-trained doctors, many of whom may migrate onwards to new destination countries. A cross-sectional study was conducted to measure and analyse the factors associated with the migratory intentions of foreign doctors in Ireland. A total of 366 non-European nationals registered as medical doctors in Ireland completed an online survey assessing their reasons for migrating to Ireland, their experiences whilst working and living in Ireland, and their future plans. Factors associated with future plans - whether to remain in Ireland, return home or migrate to a new destination country - were tested by bivariate and multivariate analyses, including discriminant analysis. Of the 345 foreign doctors who responded to the question regarding their future plans, 16 % of whom were Irish-trained, 30 % planned to remain in Ireland, 23 % planned to return home and 47 % to migrate onwards. Country of origin, personal and professional reasons for migrating, experiences of training and supervision, opportunities for career progression, type of employment contract, citizenship status, and satisfaction with life in Ireland were all factors statistically significantly associated with the three migratory outcomes. Reported plans may not result in enacted emigration. However, the findings support a growing body of evidence highlighting dissatisfaction with current career opportunities, contributing to the emigration of Irish doctors and onward migration of foreign doctors. Implementation of the WHO Global Code, which requires member states to train and retain their own health workforce, could also help reduce onward migration of foreign doctors to new destination countries. Ireland has initiated the provision of tailored postgraduate training to doctors from

  7. Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation.

    Science.gov (United States)

    Abou El Senoun, Ghada; Dowswell, Therese; Mousa, Hatem A

    2014-04-14

    Preterm prelabour rupture of membranes (PPROM) is associated with increased risk of maternal and neonatal morbidity and mortality. Women with PPROM have been predominantly managed in hospital. It is possible that selected women could be managed at home after a period of observation. The safety, cost and women's views about home management have not been established. To assess the safety, cost and women's views about planned home versus hospital care for women with PPROM. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013) and the reference lists of all the identified articles. Randomised and quasi-randomised trials comparing planned home versus hospital management for women with PPROM before 37 weeks' gestation. Two review authors independently assessed clinical trials for eligibility for inclusion, risk of bias, and carried out data extraction. We included two trials (116 women) comparing planned home versus hospital management for PPROM. Overall, the number of included women in each trial was too small to allow adequate assessment of pre-specified outcomes. Investigators used strict inclusion criteria and in both studies relatively few of the women presenting with PPROM were eligible for inclusion. Women were monitored for 48 to 72 hours before randomisation. Perinatal mortality was reported in one trial and there was insufficient evidence to determine whether it differed between the two groups (risk ratio (RR) 1.93, 95% confidence interval (CI) 0.19 to 20.05).  There was no evidence of differences between groups for serious neonatal morbidity, chorioamnionitis, gestational age at delivery, birthweight and admission to neonatal intensive care.There was no information on serious maternal morbidity or mortality. There was some evidence that women managed in hospital were more likely to be delivered by caesarean section (RR (random-effects) 0.28, 95% CI 0.07 to 1.15). However, results should be interpreted cautiously as there is

  8. Role of traditional birth attendants (TBAs) in provision of antenatal and perinatal care at home amongst the urban poor in Delhi, India.

    Science.gov (United States)

    Singh, Samiksha; Chhabra, Pragti; Sujoy, Rachna

    2012-01-01

    More than 80% of deliveries amongst the urban poor are conducted at home, mostly by traditional birth attendants (TBAs). In all, 29 eligible TBAs in the study area were identified and interviewed to assess their knowledge and practices regarding antenatal and perinatal care. Their knowledge about complications in antenatal and perinatal period was inadequate. The majority provided inadequate advice to the mothers. Over seventy-nine percent (79.3%) gave injections of oxytocin. Sixteen (55.2%) did not wait or waited for less than 10 minutes for the mother to expel the placenta. Fourteen (48.3%) encountered excessive vaginal bleeding, but none knew how to manage it. Overall knowledge and care provided by the TBAs was poor.

  9. The Home as Workplace: Investigating Home Based Enterprises in ...

    African Journals Online (AJOL)

    The research revealed the importance of home based enterprises as a major source of income generation and socialization in urban areas. Recommendations include the adoption of case-specific planning models, consideration of cultural contexts in planning and the adoption of local economic development strategies in ...

  10. Marketing energy conservation options to Northwest manufactured home buyers

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickson, P.L.; Mohler, B.L.; Taylor, Z.T.; Lee, A.D.; Onisko, S.A.

    1985-06-01

    This study relies on extensive, existing survey data and new analyses to develop information that would help design a marketing plan to achieve energy conservation in new manufactured homes. Existing surveys present comprehensive information about regional manufactured home occupants and their homes that are relevant to a potential conservation marketing plan. An independent analysis of the cost-effectiveness of various efficiency improvements provides background information for designing a marketing plan. This analysis focuses on the economic impacts of alternative energy conservation options as perceived by the home owner. Identifying impediments to conservation investments is also very important in designing a marketing plan. A recent report suggests that financial constraints and the need for better information and knowledge about conservation pose the major conservation investment barriers. Since loan interest rates for new manufactured homes typically exceed site-built rates by a considerable amount and the buyers tend to have lower incomes, the economics of manufactured home conservation investments are likely to significantly influence their viability. Conservation information and its presentation directly influences the manufactured home buyer's decision. A marketing plan should address these impediments and their implications very clearly. Dealers express a belief that consumer satisfaction is the major advantage to selling energy efficient manufactured homes. This suggests that targeting dealers in a marketing plan and providing them direct information on consumers' indicated attitudes may be important. 74 refs.

  11. [Inclusion of traditional birth attendants in the public health care system in Brazil: reflecting on challenges].

    Science.gov (United States)

    Gusman, Christine Ranier; Viana, Ana Paula de Andrade Lima; Miranda, Margarida Araújo Barbosa; Pedrosa, Mayane Vilela; Villela, Wilza Vieira

    2015-05-01

    The present article describes an experience with traditional birth attendants carried out in the state of Tocantins, Brazil, between 2010 and 2014. The experience was part of a diagnostic project to survey home deliveries in the state of Tocantins and set up a registry of traditional birth attendants for the Health Ministry's Working with Traditional Birth Attendants Program (PTPT). The project aimed to articulate the home deliveries performed by traditional birth attendants to the local health care systems (SUS). Sixty-seven active traditional birth attendants were identified in the state of Tocantins, and 41 (39 indigenous) participated in workshops. During these workshops, they discussed their realities, difficulties, and solutions in the context of daily adversities. Birth attendants were also trained in the use of biomedical tools and neonatal resuscitation. Based on these experiences, the question came up regarding the true effectiveness of the strategy to include traditional birth attendants in the SUS. The present article discusses this theme with support from the relevant literature. The dearth of systematic studies focusing on the impact of PTPT actions on the routine of traditional birth attendants, including perinatal outcomes and remodeling of health practices in rural, riverfront, former slave, forest, and indigenous communities, translates into a major gap in terms of the knowledge regarding the effectiveness of such initiatives.

  12. Quality of dying in nursing home residents dying with dementia: does advanced care planning matter? A nationwide postmortem study.

    Directory of Open Access Journals (Sweden)

    An Vandervoort

    Full Text Available Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1 advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2 the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia.Cross-sectional study of deaths (2010 using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires.We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate. A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1-11 than for those without either (AOR 2.99; CI,1.1-8.3. We found no association between verbal communication or having a GP order and quality of dying.For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as early as possible.

  13. The impact of postpartum contraception on reducing preterm birth: findings from California.

    Science.gov (United States)

    Rodriguez, Maria I; Chang, Richard; Thiel de Bocanegra, Heike

    2015-11-01

    Family planning is recommended as a strategy to prevent adverse birth outcomes. The potential contribution of postpartum contraceptive coverage to reducing rates of preterm birth is unknown. In this study, we examine the impact of contraceptive coverage and use within 18 months of a birth on preventing preterm birth in a Californian cohort. We identified records for second or higher-order births among women from California's 2011 Birth Statistical Master File and their prior births from earlier Birth Statistical Master Files. To identify women who received contraceptive services from publicly funded programs, we applied a probabilistic linking methodology to match birth files with enrollment records for women with Medi-Cal or Family Planning, Access, Care, and Treatment Program (PACT) claims. The length of contraceptive coverage was determined through applying an algorithm based on the specified method and the quantity dispensed. Preterm birth was defined as a birth occurring birth using subcategories defined by the World Health Organization: extremely preterm (birth and control for key covariates. The cohort consisted of 111,948 women who were seen at least once by a Medi-Cal or Family PACT provider within 18 months of delivery. Of the cohort, 9.75% had a preterm birth. Contraceptive coverage was found to be protective against preterm birth. For every month of contraceptive coverage, odds of a preterm birth confidence interval, 0.986-0.993). Improving postpartum contraceptive use has the potential to reduce preterm births. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Does hospital at home for palliative care facilitate death at home? Randomised controlled trial

    Science.gov (United States)

    Grande, Gunn E; Todd, Chris J; Barclay, Stephen I G; Farquhar, Morag C

    1999-01-01

    Objective To evaluate the impact on place of death of a hospital at home service for palliative care. Design Pragmatic randomised controlled trial. Setting Former Cambridge health district. Participants 229 patients referred to the hospital at home service; 43 randomised to control group (standard care), 186 randomised to hospital at home. Intervention Hospital at home versus standard care. Main outcome measures Place of death. Results Twenty five (58%) control patients died at home compared with 124 (67%) patients allocated to hospital at home. This difference was not significant; intention to treat analysis did not show that hospital at home increased the number of deaths at home. Seventy three patients randomised to hospital at home were not admitted to the service. Patients admitted to hospital at home were significantly more likely to die at home (88/113; 78%) than control patients. It is not possible to determine whether this was due to hospital at home itself or other characteristics of the patients admitted to the service. The study attained less statistical power than initially planned. Conclusion In a locality with good provision of standard community care we could not show that hospital at home allowed more patients to die at home, although neither does the study refute this. Problems relating to recruitment, attrition, and the vulnerability of the patient group make randomised controlled trials in palliative care difficult. While these difficulties have to be recognised they are not insurmountable with the appropriate resourcing and setting. Key messagesTerminally ill patients allocated to hospital at home were no more likely to die at home than patients receiving standard careAlthough the subsample of patients actually admitted to hospital at home did show a significant increase in likelihood of dying at home, whether this was due to the service itself or the characteristics of patients admitted to hospital at home could not be determinedThe need to

  15. Skilled care at birth among rural women in Nepal: practice and challenges.

    Science.gov (United States)

    Dhakal, Sulochana; van Teijlingen, Edwin; Raja, Edwin Amalraj; Dhakal, Keshar Bahadur

    2011-08-01

    In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p home. Results of univariate analysis showed that women from Brahmin-Chhetri ethnicity, women with higher education or who were more skilled, whose husbands had higher education and more skilled jobs, had first or second childbirth, and having adverse previous obstetric history were associated with institutional delivery while women with higher education and having an adverse history of pregnancy outcome predicted the uptake of skilled delivery care in Nepal. The main perceived problems to access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of skilled delivery care that were identified

  16. Environmental impacts of informal settlements with second homes (vacation homes. A case study: Apuseni Nature Park.

    Directory of Open Access Journals (Sweden)

    OANA ALEXANDRA CIUPE

    2017-10-01

    Full Text Available The past decades has seen the rapid development of second homes in many country of the world. Therefore, secondary dwellings used for tourism-related purposes (vacation homes or second homes are a reality that becomes more pronounced and visible at both nationally and internationally level. However, the rapidity and the novelty of the phenomenon creates difficulties in terms of efficient management and suitable integration in spatial planning and urbanism plans, favoring - in a negative way - expanding of build-up areas (with second homes in a chaotic way. Since there has been no detailed investigation of second homes tourism from the perspective of informal settlements, this article follows a case-study design, with in-depth analysis of informal settlements with vacation homes found in Apuseni Nature Park. Based on long-term field research, will be exemplified 4 types of informal settlements with second homes (vacation homes identified in the case study. The aim of this paper is to critically analyse the effects of informal settlements with vacation homes on the natural environment.

  17. Where there is no toilet: water and sanitation environments of domestic and facility births in Tanzania.

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    Lenka Benova

    Full Text Available Inadequate water and sanitation during childbirth are likely to lead to poor maternal and newborn outcomes. This paper uses existing data sources to assess the water and sanitation (WATSAN environment surrounding births in Tanzania in order to interrogate whether such estimates could be useful for guiding research, policy and monitoring initiatives.We used the most recent Tanzania Demographic and Health Survey (DHS to characterise the delivery location of births occurring between 2005 and 2010. Births occurring in domestic environments were characterised as WATSAN-safe if the home fulfilled international definitions of improved water and improved sanitation access. We used the 2006 Service Provision Assessment survey to characterise the WATSAN environment of facilities that conduct deliveries. We combined estimates from both surveys to describe the proportion of all births occurring in WATSAN-safe environments and conducted an equity analysis based on DHS wealth quintiles and eight geographic zones.42.9% (95% confidence interval: 41.6%-44.2% of all births occurred in the woman's home. Among these, only 1.5% (95% confidence interval: 1.2%-2.0% were estimated to have taken place in WATSAN-safe conditions. 74% of all health facilities conducted deliveries. Among these, only 44% of facilities overall and 24% of facility delivery rooms were WATSAN-safe. Combining the estimates, we showed that 30.5% of all births in Tanzania took place in a WATSAN-safe environment (range of uncertainty 25%-42%. Large wealth-based inequalities existed in the proportion of births occurring in domestic environments based on wealth quintile and geographical zone.Existing data sources can be useful in national monitoring and prioritisation of interventions to improve poor WATSAN environments during childbirth. However, a better conceptual understanding of potentially harmful exposures and better data are needed in order to devise and apply more empirical definitions of

  18. Where there is no toilet: water and sanitation environments of domestic and facility births in Tanzania.

    Science.gov (United States)

    Benova, Lenka; Cumming, Oliver; Gordon, Bruce A; Magoma, Moke; Campbell, Oona M R

    2014-01-01

    Inadequate water and sanitation during childbirth are likely to lead to poor maternal and newborn outcomes. This paper uses existing data sources to assess the water and sanitation (WATSAN) environment surrounding births in Tanzania in order to interrogate whether such estimates could be useful for guiding research, policy and monitoring initiatives. We used the most recent Tanzania Demographic and Health Survey (DHS) to characterise the delivery location of births occurring between 2005 and 2010. Births occurring in domestic environments were characterised as WATSAN-safe if the home fulfilled international definitions of improved water and improved sanitation access. We used the 2006 Service Provision Assessment survey to characterise the WATSAN environment of facilities that conduct deliveries. We combined estimates from both surveys to describe the proportion of all births occurring in WATSAN-safe environments and conducted an equity analysis based on DHS wealth quintiles and eight geographic zones. 42.9% (95% confidence interval: 41.6%-44.2%) of all births occurred in the woman's home. Among these, only 1.5% (95% confidence interval: 1.2%-2.0%) were estimated to have taken place in WATSAN-safe conditions. 74% of all health facilities conducted deliveries. Among these, only 44% of facilities overall and 24% of facility delivery rooms were WATSAN-safe. Combining the estimates, we showed that 30.5% of all births in Tanzania took place in a WATSAN-safe environment (range of uncertainty 25%-42%). Large wealth-based inequalities existed in the proportion of births occurring in domestic environments based on wealth quintile and geographical zone. Existing data sources can be useful in national monitoring and prioritisation of interventions to improve poor WATSAN environments during childbirth. However, a better conceptual understanding of potentially harmful exposures and better data are needed in order to devise and apply more empirical definitions of WATSAN

  19. Intertwining of birth-and-death processes

    Czech Academy of Sciences Publication Activity Database

    Swart, Jan M.

    2011-01-01

    Roč. 47, č. 1 (2011), s. 1-14 ISSN 0023-5954 R&D Projects: GA ČR GA201/09/1931 Institutional research plan: CEZ:AV0Z10750506 Keywords : Intertwining of Markov processes * birth and death process * averaged Markov process * first passage time * coupling * eigenvalues Subject RIV: BA - General Mathematics Impact factor: 0.454, year: 2011 http://library.utia.cas.cz/separaty/2011/SI/swart-intertwining of birth-and- death processes.pdf

  20. Correlates of antenatal body mass index (bmi as a determinant of birth weight – a longitudinal study

    Directory of Open Access Journals (Sweden)

    Saurabh Rambiharilal Shrivastava

    2012-09-01

    Full Text Available Objectives: To study the correlation between Body Mass Index (BMI in antenatal period and birth weight of child, along with the socio-demographic determinants of birth weight. Methods: A longitudinal study of one-year duration, from June 2010 to May 2011, was conducted in an urban slum of Mumbai, India. Universal sampling method was employed, including as subjects all pregnant women with minimum two Antenatal Care (ANC visits - and at least one in the third trimester - registered at an urban health centre from June to August 2010. Subjects with any pre-existing co-morbid illness or with past history of giving birth to twins or to any congenitally malformed child, or else, with outcome of still births or home delivery, were excluded. These women were followed up for the next months until delivery. Maternal weight was recorded at each visit and BMI was calculated, or the average BMI, in case of more than one visit in any trimester. Birth weight was recorded using hospital or maternity home records. Results: Prevalence of low birth weight was 26.7%. Correlation between maternal BMI of third trimester and neonatal birth weight was moderately positive. 60.8% of variability in birth weight can be predicted by maternal BMI in third trimester. Conclusions: Third trimester BMI can be used as a predictor of neonatal birth weight. Information, Education and Counseling (IEC activities regarding utilization of Antenatal Care (ANC services can help reducing the incidence of Low Birth Weight (LBW.

  1. Use of maternity waiting home in rural Zambia.

    Science.gov (United States)

    van Lonkhuijzen, Luc; Stegeman, Margreet; Nyirongo, Rebecca; van Roosmalen, Jos

    2003-04-01

    This study was conducted to assess the results from the use of a maternity waiting home, a health facility to which women with high risk pregnancies are referred during the last weeks of pregnancy in rural Zambia. It compared the risk status and pregnancy outcome in women staying as waiters with those women who give birth in hospital after direct admission (non-waiters). Forty seven per-cent of the non-waiters (n = 292) had no maternal risk factors and 85% had no antenatal risk factors as compared to 17% and 78% among the waiters (n = 218). Eighty six per cent of waiters had spontaneous vaginal vertex delivery as compared to 95% of non-waiters. Although the differences in risk status were statistically significant, no differences were found in birth weight and maternal and perinatal mortality. The similar obstetric outcome among waiters with more high risk pregnancies and non-waiters could be interpreted as a possible outcome of the maternity waiting home. When dependent on a proper functioning referral system, such waiting homes can reduce perinatal mortality.

  2. Maternity waiting homes in Southern Lao PDR: the unique 'silk home'.

    Science.gov (United States)

    Eckermann, Elizabeth; Deodato, Giovanni

    2008-10-01

    The concept of maternity waiting homes (MWH) has a long history spanning over 100 years. The research reported here was conducted in the Thateng District of Sekong Province in southern Lao People's Democratic Republic (PDR) to establish whether the MWH concept would be affordable, accessible, and most importantly acceptable, as a strategy to improve maternal outcomes in the remote communities of Thateng with a high proportion of the population from ethnic minority groups. The research suggested that there were major barriers to minority ethnic groups using existing maternal health services (reflected in very low usage of trained birth attendants and hospitals and clinics) in Thateng. Unless MWH are adapted to overcome these potential barriers, such initiatives will suffer the same fate as existing maternal facilities. Consequently, the Lao iteration of the concept, as operationalized in the Silk Homes project in southern Lao PDR is unique in combining maternal and infant health services with opportunities for micro credit and income generating activities and allowing non-harmful traditional practices to co-exist alongside modern medical protocols. These innovative approaches to the MWH concept address the major economic, social and cultural barriers to usage of safe birthing options in remote communities of southern Lao PDR.

  3. Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study

    OpenAIRE

    Gill, Christopher J; Phiri-Mazala, Grace; Guerina, Nicholas G; Kasimba, Joshua; Mulenga, Charity; MacLeod, William B; Waitolo, Nelson; Knapp, Anna B; Mirochnick, Mark; Mazimba, Arthur; Fox, Matthew P; Sabin, Lora; Seidenberg, Philip; Simon, Jonathon L; Hamer, Davidson H

    2011-01-01

    Objective To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare. Design Prospective,